23- 
24- 
25- 
26 
27. 
28. 
29. 
3" 
3i- 

3 2 - 

33 
34 
35- 
36- 



Frontal Bellies of the Occipito- Frontalis. 
Orbicularis Palpebrarum. 
Levator Labii Superioris Alaeque Nasi. 
Zygomaticus Minor. 
Zygomaticus Major. 
Masseter. 
Orbicularis Oris. 
Depressor Labii Inferioris. 
Platysma-Myodes. 
Deltoid. 

Pectoralis Major. 

Axillary portion of the Latissimus Dorsi. 
Serratus Major Anticus. 
Biceps Flexor Cubiti. 
Anterior portions of the Triceps Exten- 
sor Cubiti. 
Supinator Radii Longus. 
Pronator Radii Teres. 
Extensor Carpi Radialis Longior. 
Extensor Ossis Metacarpi Pollicis. 
Annular Ligament. 
Palmar Fascia. 

Obliquus Externus Abdominis. 
Linea Alba. 

Tensor Vaginae Femoris. 
Section of the Spermatic Cord. 
Psoas Magnus. 
Adductor Longus. 
Sartorius. 
Rectus Femoris. 
Vastus Externus. 

Vastus Internus. ^ 

Tendon Patellae. 
Gastrocnemius. 
Tibialis Anticus. 
Tibia. 
Tendons of the Extensor Communis. 




VIEW OF THE ANTERIOR MUSCLES OF THE BODY. 



'73f~/ 



THE 



MEDICAL ADVISER: 



FULL AND. PLAIN TREATISE 



ON THE 



THEORY AND PRACTICE OF MEDICINE. 



ESPECIALLY ADAPTED TO 



FAMILY USE. 



BY 



REZIN THOMPSON, M. D., 

PERMANENT MEMBER OF THE AMERICAN MEDICAL ASSOCIATION, AND AUTHOR OF 
" THOMPSON ON FEVER," ETC 



NATIONAL PUBLISHING CO., 

CINCINNATI, O., AND MEMPHIS, TENN. 

JONES, JUNKIN & CO., CHICAGO, ILL. 

1870. 



-^6 



Entered, according to Act of Congress, in the year 1870, by 



J. T. JONES, 



In the Clerk's Office of the District Court of the United States for the 

Southern District of Ohio. 



PUBLISHERS' PREFACE. 



In the course of a long experience in the publication 
and sale of standard works, the publishers have every- 
where found a great demand for a reliable household 
medical work. While the volume of medical science 
contains mysteries which it must ever be the province of 
professional men to unravel, it does not follow that to the 
general public it must forever remain a sealed book. That 
a majority of the intelligent men and women of our coun- 
try are profoundly ignorant of the nature, causes, and 
proper treatment of the diseases to which they are liable, 
is because this knowledge, the result of scientific investi- 
gation and research, has remained in the language and no- 
menclature of science, and practically beyond their reach. 

What is needed is a full, accurate, and reliable treatise, 
giving a clear analysis and description of the nature, causes, 
and symptoms of the diseases to which flesh is heir, with 
their remedies and mode of treatment, written in language 
intelligible to the non-professional reader. 

Many attempts have already been made to supply this 
universal need. Of these, some have been brought for- 
ward by medical mountebanks, who sought, under the dis- 
guise of a medical treatise, to puff their own nostrums; some 
have been devoted almost entirely to a favorite theory; oth- 
ers have been mere essays on family government, morals, 
etc.; while still others have been scarcely more than pre- 
scription books, containing but little medical information. 

It has seemed to us that the following are some of the 

(iii) 



iv publishers' preface. 

requisites of a work which would command the confidence 
and approval of the public. 

First of all, it must be written by a physician of un- 
doubted character and reputation. If men will not trust 
their lives in the hands of a physician, except they have 
confidence in his skill and judgment, neither should they 
put their faith in a book whose author does not inspire 
similar confidence. He must therefore be a man of 
thorough scientific attainment, of large experience, and 
ripe judgment; one whose name alone will be a sufficient 
guarantee of the accuracy and reliability of his statements. 

Second: The aim of the work must be, not to promul- 
gate a special theory, but simply to impart correct and re- 
liable medical information. 

Third: In its subject-matter it must be full and compre- 
hensive. It should give the reader such information as 
will make him an intelligent guardian of his own health, 
enable him to detect the approach of disease, and apply a 
remedy before it has fastened itself upon his system. 

It should give careful directions for the treatment of 
every disease described, and, so far as possible, suggest 
remedies simple and easily obtained. 

Fourth: The style of the work should be plain, clear, 
and direct. Technical terms and phrases should be avoided, 
as far as possible, and, where used, be fully explained. 
Simplicity and clearness should also be studied in the ar- 
rangement and classification of the work, and the index 
should be full and complete. 

We believe that the work we now offer combines these 
requisites in an eminent degree. It has already received 
an unmistakable indorsement in the rapid exhaustion of 
the first edition, and we feel confident that it needs only 
to be brought to the notice of all to make it a Medical Ad- 
viser to every family in the land. 



TABLE OF CONTENTS. 



FEVER. 
CHAPTEK I. 

PAGE. 

Its Nature and Phenomena, 25 

CHAPTEK II. 
Causes op Fever, 45 

CHAPTEK III. 
Treatment op Fever, 49 

CHAPTEK IY. 

THEORIES OP PEVER. 

Humoral Theory, 58 



Spasmodic 

Sympathetic 

Phlegm asian 

Cooke's 

Thompsonian 

Present 

Modes of Cure 



59 
61 
62 
64 
65 
68 
72 



CHAPTEK Y. 

Mysteries Connected with Fever, 77 

How Fever Terminates in Health, 86 

How Fever Cures Other Diseases, 88 

How Tartar Emetic Acts in Producing a Crisis, 91 

On Delirium in Fever, 92 

Critical Days, 94 

How an Inflammation may Cure a Fever, 97 

How do Contagious Diseases Procure an Immunity from the 

Disease Thereafter, 99 

M 



VI CONTENTS. 

/ 

PAGE. 

Does the Continued Action of the Eemote Cause increase its 

Intensity, etc., 101 

How does Quinine Cure Intermittents, 106 

Modus Operandi of Topical (Local) Eemedies, 109 

How does Spirits of Turpentine Act Beneficially in Typhoid 

Fever, Ill 

How do Mercurials Act Injuriously in Typhoid Fever, . . 114 

CHAPTEE VI. 

PARTICULAR FEVERS. 

Typhoid Fever, 118 

Bilious or Miasmatic Fever, . . . 134 

Congestive Chills, 148 

Treatment of Congestive Fever, * . 152 

Pulmonic Fever — Pneumonia, 154 

Yellow Fever, 164 

Dysenteric Fever — Dysentery — Flux, 169 

Cholera Infantum, or Summer Complaint, 191 

CHAPTEE VII. 

ERUPTIVE FEVERS. 

Variola, or Small-Pox, 194 

Vaccine Disease, 198 

Varicella, or Chicken-Pox, 202 

Scarlatina — Scarlet Fever, 204 

Eubeola — Measles, 213 

Erysipelatous Fever — Erysipelas, 216 

Diphtheria, 230 



INFLAMMATION. 
General Eemarks, 237 

CHAPTEE I. 

PARTICULAR INFLAMMATIONS. 

Pleuritis, or Pleurisy, 256 

Carditis, or Inflammation of the Heart, 262 

Pericarditis, or Inflammation of the External Covering of the 

Heart, 262 



CONTENTS. Vll 

PAGE. 

Endo-Carditis, or Inflammation of the Inner Lining of the 

Heart, 267 

Yalvular Diseases of the Heart, 268 

Hepatitis, or Inflammation of the Liver, ....... 270 

Gastritis, or Inflammation of the Stomach, 280 

Acute, 280 

Chronic, 287 

Inflammation of the Bowels, 298 

" " Duodenum, 299 

Enteritis, or Inflammation of the Small Intestines, .... 302 

" Chronic, 307 

Splenitis, or Inflammation of the Spleen, 311 

Nephritis, or Inflammation of the Kidneys, 313 

Cystitis, or Inflammation of the Bladder, 317 

Peritonitis, or Inflammation of the Peritoneum, .... 317 

Phrenitis, or Inflammation of the Brain, 327 

CHAPTEE II. 

SPECIFIC INFLAMMATIONS. 

Scrofula, or Tuberculosis, 331 

Phthisis — Consumption, 372 

Carcinoma, or Cancer, 386 

Syphilis, . . 397 

Chancroid, 402 

Gonorrhea, 404 

Gleet, 409 

Acute Eheumatism, 411 

Chronic " 423 

Nervous " 425 



FUNCTIONAL DERANGEMENTS. 
General Eemarks, 432 

CHAPTEE I. 

functional derangements of the digestive organs. 

Dyspepsia, 435 

Irritation of the Stomach, 450 



Vlll CONTENTS. 

PAGK 

Cardialgia and Gastrodynia, 455 

Pyrosis — Waterbrash, 458 

Spasm or Cramp of the Stomach, 460 

Nausea and Yomiting, 463 

Sick Headache, 468 

Morbid Appetite, 470 

Diarrhea, 473 

Colic, 478 

Constipation, 483 

Obstruction of the Bowels, 491 

Spasm of the iEsophagus, 497 

Cholera Morbus, 499 

Epidemic Cholera, Asiatic Cholera, 503 

Jaundice, .... 527 

CHAPTEE II. 

FUNCTIONAL DERANGEMENTS CONNECTED WITH RESPIRATION. 

Cold, or Catarrh, 535 

Influenza, or Epidemic Catarrh, 536 

Whooping-Cough, 539 

Asthma, 544 

Spasm of the G-lottis in Infants, 550 

" " Adults, 553 

Loss of Yoice, or Aphonia, 553 

Coryza — Inflammation of the Nostrils, 555 

Ozsena— Chronic " " " 557 

Laryngitis, 559 

Croup — Cynanche Trachealis, 562 

CHAPTEE III. 

FUNCTIONAL DERANGEMENTS CONNECTED WITH THE CIRCULATORY 

SYSTEM. 

General Eemarks, 565 

Palpitation of the Heart, 567 

Syncope, or Fainting, 569 

Angina Pectoris — Neuralgia of the Heart, 572 

Arterial Palpitation, 577 

Plethora, 578 



CONTENTS. IX 



PAGE. 



Anseinia, Acute, 582 

Chronic Ansemia — Chlorosis, 583 

Purpura, 587 

Scorbutus, or Scurvy, 587 

Hemorrhage, *. . . 588 

Particular Hemorrhages, 595 

Epistaxis, or Bleeding from the Nose, 595 

Hemorrhage from the Eectum — Eleeding Piles, .... 597 

Menorrhagia, or Uterine Hemorrhage, 598 

Hemorj hage from the Liver, 598 

" " Skin, 599 

CHAPTER IY. 

FUNCTIONAL DERANGEMENTS CONNECTED WITH THE SECRETORY 

ORGANS. 

General Remarks, 600 

Dropsy, G-eneral Treatment, 600 

Anasarca — Dropsy of the Cellular Tissue, 618 

Hydrocephalus, " " Brain, 620 

Hydrothorax, " " Chest, 622 

Hydropericardium, Dropsy of the Heart, 624 

Pulmonary (Edema, " " Lungs, 625 

Ascites, " " Abdomen, 626 

Encysted Dropsy, Ovarian Dropsy, . . . 630 

CHAPTER Y. 

FUNCTIONAL DERANGEMENTS OF THE URINARY ORGANS. 

Nervous Affections — Neuralgia of the Bladder, ...... 631 

Calculous Nephralgia — Spasm of the Ureters, 632 

Spasm of the. Bladder, 634 

Paralysis or Debility of the Bladder, 635 

Strangury, 637 

Disorders of Secretion and Excretion, 638 

Diuresis — Abundant Flow of Urine, 640 

Diabetes — Saccharine Urine, 642 

Ischuria — Suppression of Urine, 646 

Lithiasis — Calculous Disease — Gravel, 649 

Phosphatic Lithiasis, 652 



X CONTENTS. 

PAGB 

Oxalic Lithiasis, 654 

Eetention of Urine, Eenal, 665 

" " Yesical, 6QQ 

Incontinence of Urine, 670 

CHAPTEE VI. 

FUNCTIONAL DERANGEMENTS CONNECTED WITH THE NERVOUS SYSTEM. 

Nervous Irritation, 674 

Yascular Irritation, or Active Congestion, 675 

Depression, 677 

Mechanical or Passive Congestion, 679 

Headache, or Cephalalgia, 679 

Stupor and Wakefulness, . . 684 

Mental Disorder, 685 

Ecstasy, 686 

Somnambulism — Sleep-Walking, 687 

Motor Disorder, Convulsions, 688 

Catalepsy, . 694 

Insanity — Mental Derangement, 695 

Mania — Madness, 697 

Dementia — Idiocy, 698 

Moral Insanity, 698 

Monomania, 699 

Delirium Tremens — Mania a Potu, 700 

Paralysis — Palsy, 703 

Hemiplegia, 704 

Paraplegia, 705 

Mercurial Palsy, Lead Palsy, 706 

Paralysis Agitans — Shaking Palsy, 707 

Epilepsy — Convulsive Fits, 709 

Hysteria, 712 

CHAPTEE YIL 

FUNCTIONAL DERANGEMENTS OF THE SPINAL MARROW. 

Chorea — St. Yitus's Dance, 714 

Spinal Irritation, 716 

Tetanus — Locked Jaw, 718 



CONTENTS. XI 



PAGE. 



Hydrophobia — Canine Madness, 724 

Neuralgia, 729 



DISEASES OF THE SKIN. 

General Eemarks, 739 

Erythema — Scarlet Eose, 741 

Nettle Eash — Urticaria, 742 

Lichen, 743 

Prurigo, or Itching Tetter, 744 

Herpes, or Creeping Eruption, 745 

Eczema, or Hot and Painful Eruption, 745 

Scabies — Itch — Itching Tetter, 747 

Miliary Eruption, Pemphigus, 748 

Eupia, Ecthyma, 749 

Impetigo — Moist Tetter, 750 

Porrigo — Scald-Head, 750 

Acne, 751 

Eosacea, or Eoselike, 751 

Psoriasis— Dry Tetter, 752 

Ringworm — Porrigo Scutulata, 752 

Pityriasis, or Dandruff, 753 

Corns, 754 

Warts, 755 



MISCELLANEOUS DISEASES. 

Apoplexy, 756 

Concussion of the Brain, 760 

Odontalgia — Toothache, Nervous, 761 

Inflammatory, 763 

Eheumatic and Gouty, 767 

Falling of the Teeth, 768 

Mumps — Parotitis, 768 

Hemorrhoids — Piles, 771 

Phlegmasia Dolens — Milk-Leg, 779 



U It 

u a 



Xll CONTENTS. 



PAGB, 



Bright's Disease — Fatty Degeneration of the Kidney, . . 783 

Dysphonia Clericorum — Clergyman's Sore Throat, . . . 783 

Intestinal Worms, 785 

Ascaris Lumbricoides — Eound-Worm, 789 

Ascarides — Thread-Worm, 792 

Trichocephalus Dispar — Long Thread-Worm, 793 

Taenia Solium — Common Tape-Worm, 794 

Prolapsus Ani, 796 

Volvulus, or Intussusceptio, 799 



WOUNDS, INJURIES, AND ACCIDENTS. 

Wounds, ". 800 

Fractures and Dislocations, 803 

Of Poisoned Wounds, 810 

Sting of Insects, . 811 

Eite of Eeptiles, 811 

Scalds and Burns, . . . . ■. 814 

Effects of Cold, 818 

Chilblains, 819 



ASPHYXIA— SUSPENDED ANIMATION, 821 



MIDWIFERY. 

CHAPTEE I. 
General Eemarks, 826 

Sketch of the Anatomy of the Female Eeproductive Organs, 827 

The External Organs, '828 

The Internal Organs, 832 

CHAPTEE II. 

FEMALE DISEASES.' 

Menstruation, 836 

The Consequence of the Neglect of the Menstrual Function, 839 



CONTENTS. XU1 

PAGE. 

Amensia — Eetention of Menses, 841 

Amenorrhea — Suppression " 842 

Profuse Menstruation, 843 

Painful " • 844 

Case of Unruptured Hymen, 850 

Leucorrhea — Whites, 852 

Prolapsus Uteri — Falling of the Womb, 855 

Inversion " " 857 

Antrove^sion " " 858 

Irritation and Ulceration " " 860 

CHAPTEE III. 

DISEASES PECULIAR TO PREGNANCY. 

General Eemarks, 868 

On the Use of the Extract of Hyoscyamus and Oil of Sassafras 

in some of the Misfortunes attendant on Pregnancy, . 869 

CHAPTEE IY. 

Practical Midwifery, 879 

Management of the Woman after Delivery, 885 

Management of the Child, 887 

CHAPTEE Y. 

DISEASES PECULIAR TO INFANTS. 

General Eemarks, 890 

Eed-Gum, Hives, or Strophulus, 890 

MATEEIA MEDICA, 904 

Formulas or Eecipes, . . • 952 

Tables of Medicine, 963 



APPENDIX. 

Hernia — Eupture, 967 

Marriage — Child-Bearing, 970 



GLOSSAEY 97 



Index of Materia Medica and Eecipes, 1017 

Index, 1019 



LIST OF ENGRAVINGS. 



FACE PAGE 

Yiew of the Anterior Muscles of the Body, . . Frontispiece. 

Front Yiew of the Adult Skeleton, xxvi 

A Side Yiew of the Superficial Arteries and Yeins of the 

Face and Neck, 154 

A Yiew of the Bronchia and Blood-vessels of the Lungs, 154 

A Back Yiew of the Adult Skeleton, :....... 236 

Posterior Yiew of the Muscles of the Body, . . . . 396 

A Yiew of the Organs of Digestion, 478 

Arterial System, 566 

A Yiew of the Yiscera, 626 

A Yiew of the Facial Nerve, 626 

Long Tapeworm. (Taenia solium.) 786 

Trichina. (Tricocephalus dispar.) 786 

Calamus, 908 

Bloodroot. (Sanguinaria Canadensis.) 908 

Bearberry. (Uva Ursa.) 908 

G-entian. (Gentiana lutea.) 920 

Hemlock. (Gonium Maculatum.) 920 

Purple Fox-Glove. {Digitalis purpurea.) 922 

Pinkroot. (Spigelia Marilandica.) 922 

Black Henbane. (Hyoscyamus niger.) 922 

May Apple. (Podophyllum Peltatum.) 928 

Eue. (Buta Graveolens.) 928 

Dandelion. (Pens Leonis.) 928 

Camomile. (Anthemis.) 936 

Poke Weed. (Phytolacca decandra.) 936 

Seneca Snakeroot. (Polygala Senega.) 942 

Black Snakeroot. (Aristolochia Serpentaria.) 942 

Deadly Nightshade. (Atropa Belladonna.) 942 

Boneset. (Eupatorium perfoliatum.) 946 

Thorn Apple. (Patura Stramonium.) ■ 946 

(xiv) 



INTRODUCTION. 



The author having been many years engaged in observ- 
ing and treating disease, and ever watchful for any develop- 
ments which might throw new light upon its nature, or lead 
to a better or safer treatment, came to the conclusion 
that he had made some progress ; and, from time to time, 
made known to the profession his views upon various sub- 
jects through the medium of the press, medical societies, 
and occasional lectures to the students of Nashville Medical 
College. Finally he published a little book, entitled " Thomp- 
son on Fever, Dysentery, etc.," in which he gave whatever 
he esteemed new and valuable upon the subjects treated of 
in the work. The work was kindly received by the profes- 
sion, and the treatment recommended has been generally 
found to be much more successful than any other previously 
adopted ; in fact, the success of most of those who have 
reported appears to be unprecedented. As the first edition 
was soon exhausted, a second was imperatively called 
for; the author accordingly prepared an enlarged edition, 
which was rapidly disposed of. Quite a number of farmers 
and others, not of the profession, obtained the work, and 
had been enabled to manage their own cases of fever, 
pneumonia, dysentery, etc., very successfully. But as it 
was written expressly for physicians, though not abounding 
in technicalities, yet was not quite plain enough to suit 
the common reader ; and then only a few diseases having 
been treated of, many such importuned the author to write 

(xv) 



XVI INTRODUCTION. 

a general practice, suited to families, so that they might 
have something to guide them in the absence of a physician. 
But he felt rather a dislike for family medical books, being 
perhaps prejudiced against them by the fact that the most 
he had examined had been written by very incompetent 
persons, abounding in bad treatment and worse language, 
the writers not knowing how to be plain without descending 
to vulgarisms. Others, on the contrary, were written in a 
style above the comprehension of ordinary readers, and all 
far behind the teachings of the age. 

That a work written in good, plain style, and so worded 
that common decency would not be outraged by having it 
read aloud in the family, and containing such information 
as would enable the reader to guard against the encroach- 
ment of many diseases, or arrest them in the forming stage, 
would be eminently useful, and prevent much suffering, no 
one can deny; and as many partial friends had impressed 
it upon the author that he possessed the peculiar qualifica- 
tions necessary to write such a work as it should be done, 
he finally came to the conclusion that he could in this 
way do some good for his fellows, and obtained his own 
consent to undertake the task. 

But being fully aware that it was no light task — a 
much harder one than preparing a general work for the 
profession would be, because it would be more minute and 
more carefully worded, and greater pains required to say 
just enough to be understood, and not so much as to 
weary or produce confusion : — all this, and more, being 
perceived and appreciated, occasioned a shrinking from the 
task; and would perhaps have occasioned an indefinite 
postponement of the work, but that a friend, who had 
devoted much of his life to disserninating family medical 
works among the people, had come to the conclusion 



INTRODUCTION. Xvii 

that no work of the kind could then be obtained that was 
up to the teachings of the age, and approached me with the 
purpose of obtaining my aid in making such a revision as 
would remedy this serious defect. I accordingly looked 
over the works which he had been circulating, to see if such 
a thing could be easily done, and finally informed him that 
the works were so exceedingly imperfect in style, and em- 
braced so little really valuable information, being taken up 
principally with very poor dissertations upon morals, family 
government, etc., and then were so very far behind the pre- 
sent improvements in medicine, that I could not undertake 
the task of a revision, as it would be a more onerous duty 
than writing a new work — which he importuned me to un- 
dertake, as he had made arrangements for going into the busi- 
ness extensively, and was obliged to have a work published. 
After mature deliberation I came to the conclusion that 
perhaps duty enjoined upon me the task, and consented to 
undertake it. How well I succeeded in meeting the ex- 
pectation of friends may be inferred from the fact that a 
large sale of the work was effected in a very short time; 
but our unhappy troubles coming on suddenly put a stop 
to the enterprise. When the present publishers deter- 
mined to re-issue the work they requested the author to 
revise it; for, as near ten years had elapsed since the last 
edition was printed, it was reasonable to suppose that 
changes would be necessary to bring the teachings up to 
the advancements of the age. After looking over it very 
carefully, although he thought it advisable to treat upon 
several subjects not noticed before, and enlarge upon others, 
yet he found no occasion for any change, either in theory 
or practice. The truth is that when this work was first 
written it was much in advance of medical teaching at that 
time. The author had, for near fortv years, labored zeal- 



XV111 INTRODUCTION. 

ously and unceasingly in the search of truth in medical 
science, unfettered by prejudice and untrammeled by au- 
thority further than enlightened experience, and truth 
gave it weight. He, as it were, entered into the mines 
himself, dug up the primal formations, smelted the ores, 
threw away the dross, and preserved only the pure gold. 
The wise man hath said that "truth is more precious than 
gold." It is also more enduring. What was true once is 
true now, and will be forever. 

While the author was searching after truth in medical 
science, multitudes all over the earth were engaged in the 
same pursuit, and quite a number in different parts of the 
world, without co-operation, without consultation, arrived at 
the same conclusion at nearly the same time. But the au- 
thor claims to have been the first who published a system- 
atized view of what is now known as conservative medicine. 

Twenty years ago the doctrines which he taught were 
so new that their avowal caused him much persecution, 
and came near causing him to be ostracized from the 
brotherhood of legitimate medicine. But when some of the 
lights of the profession in Europe, some years later, came 
out with an avowal and able defense of substantially the 
same doctrines, the opposition began to die away, and now 
the author's peculiar views are the standard doctrines of 
the profession. But, notwithstanding that the medical 
world has revolved until it occupies the same plane upon 
which he stood twenty years ago with regard to science, 
yet he claims and assuredly believes that no materia 
medica, no means of cure, has yet been published which 
will compare in efficacy with the simple remedies which 
are chiefly relied on in this work. A further experience 
of ten years, part of which he did an extensive practice, 
and the experience of hundreds of other intelligent prac- 



INTRODUCTION. XIX 

titioners who have adopted his mode of practice, have 
fully sustained all that he ever claimed for his favorite 
remedies. No change has, therefore, been made, in this 
respect, in this edition of the Adviser; but, in order that 
its readers may have a chance of varying the means of 
cure without injury to patients, he has introduced into 
the chapter on formulas quite a number of prescriptions 
not in any former edition,, all of which are based upon his 
own experience, or furnished by the very best practition- 
ers of the country, and commend themselves to his appro- 
bation by their being true to correct medical science. 

As the author has for over forty years been a member 
of the regular medical profession, and has labored hard, if 
not successfully, in advancing its usefulness and guarding 
its honor, he of course feels himself identified with its in- 
terests, and would be slow to undertake any enterprise that 
would in any way be in opposition to the one or the other. 
But he is very certain that to furnish the people with cor- 
rect medical information is the only successful means of 
securing proper respect for honorable, scientific medicine, 
in contradistinction to the isms, humbuggery, and quackery 
of the day. 

The fact is, that the profession has been sadly lacking in 
its duties to itself, and to the people, in this respect. No 
adequate efforts have ever been made for furnishing the 
masses with a pure and correct medical literature, and of 
course the people receive their medical ideas principally 
from quack advertisements, almanacs, and puffs of charla- 
tans, whose trade it is to decry and caricature the regular 
profession. Even the very best writers of family medical 
books have not thought it worth while to reason with the 
people, or teach them " the why and the wherefore" of their 
prescriptions ; taking it for granted, I suppose, that the peo- 



XX INTRODUCTION. 

pie would not comprehend the science of diseased action. 
But I am very confident that this is a mistake, and that 
if the truth is presented in a plain and clear style, it 
will be attractive, and will be studied, and understood suffi- 
ciently at least to enable the reader to perceive the distinc- 
tion between science and pretence. But I do not enter- 
tain the idea that this or any other work will ever make 
the people their own physicians, so as to supersede the 
services of the men who make medicine the business of 
their lives. Nothing short of entire devotedness to the 
subject can qualify a man for the important business of 
taking charge of the lives of his fellows; and unceasing 
attention to the subject is essential for keeping posted as to 
the progress of the science, and the varying types of disease. 

If this be true, says one, why should I purchase your 
work, and waste time in reading it, if I have to call on a 
doctor at last when sickness comes ? 

There are sufficient reasons, my good friend, why 
you should. First, if the work is written as it should 
be, as a purely literary work its perusal and study 
will pay by the enlargement of your ideas and the 
improvement of your style, if that is not already good. 
Secondly, it will pay by enabling you to know the approach 
of disease, and, by the timely use of means, prevent its full 
development. Thirdly, it will enable you to manage many 
cases without medical advice, and by being familiar with 
the signs of amendment, or of a dangerous turn of the disease, 
will prevent you from sending for your physician unneces- 
sarily, or of deferring it too late. And, fourthly, it will 
pay by qualifying you for better judging of the qualifica- 
tions of those who hold themselves as physicians ; for to be 
guarded against pretence and imposture, or even stupidity 
assuming the garb of wisdom, is no small matter — your all 



INTRODUCTION. XXI 

of life may depend on it. So I insist that you procure 
correct medical information ; and if this work should fail in 
presenting it in the most attractive form, or in the simplest 
language, recollect it deals in grave truths, and not in 
pleasing fancies, and that unknown facts often require the 
use of words also previously unknown; but, at any rate, 
seek medical information, and if you can find it purer or 
better dressed elsewhere, seek it there. 

But, although the author claims to be of the regular 
medical profession, and has in this work given its teach- 
ings as set forth by the best and latest authors, yet in 
some things he differs from many of his brethren, and has 
given the reader the benefit, as he thinks, of this difference, 
but has also given the treatment by others in such cases. 
It is, however, only in reference to fever that he holds 
peculiar views; and since he made these views known, or 
within the last fifteen years, many of the most prominent 
physicians, both in Europe and the United States, have 
advanced very similar doctrines, so that at present the 
author's peculiar treatment of fevers is in harmony with 
the tendency of the age ; but its unusual success would 
entitle it to acceptance unsupported by authority. 

It is with reference to febrile diseases that the author 
has felt himself called on more particularly "to give a 
reason for the faith that is in him," and he hopes to be 
heard patiently, for his object is the good of the reader, 
and not his own advantage ; for he has sacrificed much for 
" the defence of the truth," and is now too old to be elated 
by success, however brilliant. 

Before entering upon the main body of this work, it will 
be well to take a hasty view of parts of the human body 
usually referred to in reference to diseases, and of the 
classes of remedies commonly prescribed, so that the reader 



XX11 INTRODUCTION. 

may better understand what is meant when terms are used 
significant of these things. 

DIVISIONS OF THE HUMAN BODY. 

As there are certain divisions of the body which are 
often referred to in connection with the descriptions of 
diseases, it will be well at the outset to point them out, 
and give the names by which they are designated. The 
grand divisions are, the head, trunk, and extremities. The 
head is divided into the head proper, or all that part usually 
covered with hair, and the face, including the forehead, 
eyes, ears, nose, and the upper and lower jaws, or maxilla. 
The trunk is divided into the neck, chest or thorax, the 
abdomen, pelvis or basin, and the back-bone or spinal 
column, which is again divided into its cervical portion, 
forming the neck ; dorsal, to which the ribs are joined ; the 
lumbar, forming the small of the back ; and the sacrum and 
coccyx, which terminate the column. The chest, or thorax, 
comprises all that part of the trunk included within the 
ribs and breast-bone, or sternum, and contains the heart and 
lungs, or lights. The abdomen is the space between the 
ribs and the bones of the pelvis, and contains principally 
the stomach, bowels, liver, pancreas, spleen, and urinary 
bladder ; its divisions are — the epigastrium, or pit of the 
stomach; the right and left hypochondria, which are the 
spaces on each side of the epigastrium, or pit of the 
stomach; the umbilical region, or the middle portion, of 
which the navel forms the centre ; on each side of which 
the space is called the hypogastrium. Below the right and 
left hypogastrium, and above the groin, the space is called 
the iliac region, and between those in front, and situated 
between the umbilical region and. the pubes, or share bone, 
is the pubic region. 



INTRODUCTION. XX111 

In order to fix these divisions of the abdomen in the 
memory of the reader, we will again refer to them in con- 
nection with the organs which are principally found in each. 
The stomach is found in the epigastric region, and hence its 
complaints are referred to this part. The end of the breast- 
bone forms about the centre of the epigastrium, for the 
diaphragm or midriff which divides tfye chest from the 
abdomen rises upward in the middle, and allows a part of 
the stomach and liver to lie above the line of the ribs. 
The liver is principally found in the right hypocliondrium, 
but its thinner edge extends across the epigastrium, and 
frequently reaches the left hypochondrium. The great 
bowel, or colon, crosses from the right liypogastrium between 
the navel and the end of the breast-bone, and reaches the 
left hypogastrium, and then descends ; this is called the 
arch of the colon. Hence, in wind colic the pain is com- 
monly felt to commence in the right side, and extend across 
the bell}" to the left, where it descends, and, if the wind be 
expelled, for a time ceases ; but it may return by a reverse 
motion in the bowel, and then the misery will be felt 
crossing from the left to the right side. The small intes- 
tines are mostly contained in the middle or umbilical region 
— the umbilicus, or navel, being the centre ; hence, when 
they are the seat of suffering, it is felt mostly near this 
point. The spleen lies obliquely across the left side of the 
belly, extending from a little to the left of the end of the 
breast-bone, or centre of the epigastrium, downward, and 
toward the left groin ; so that it principally is found in the 
left hypogastrium, and when much enlarged, as in the ague 
cakes in old cases of fever and ague, it often is felt ex- 
tending from the breast-bone to the hip. The kidneys 
are seated one on each side of the lumbar vertebra, or 
bones of the small of the back, and are said to lie in the 
lumbar region. 



XXIV INTRODUCTION. 

The ovaries of the female lie In each iliac region, and 
hence, when the seat of irritation from cold or deranged 
menstruation, the uneasiness is felt a little above the groin. 
The bladder lies behind, and, when full, above the centre 
of the pubes or front bone, and is said to be in the pubic 
region. The basin, or pelvis, contains principally the womb 
in the unimpregnated state, the vagina, the bladder when 
empty, and the rectum, or lower gut. 

The upper extremities are divided into the shoulder, the 
arm, extending from the shoulder to the elbow, the forearm, 
the wrist, and the hand. The lower extremities are divided 
into the hip, the thigh, the leg, the ankle, and the foot. 

CLASSIFICATION OF MEDICINES. 

Medicines are divided into external and internal. Exter- 
nal remedies may either be general, as the hot and cold 
bath ; or topical, when only applied to a particular part, as 
blisters, poultices, etc. 

Topical remedies have received names which designate 
or point out the particular effect which is produced, as — 

Rubefacients, or means which excite the skin, as the 
various stimulating liniments. 

Epispastics, those which cause blistering. 

Emollients, or applications which soften the skin and 
allay irritation, as mild poultices. 

Discutients, or such as tend to discuss or drive away 
swellings or risings. 

Refrigerants, or those which allay heat, etc. 

Internal remedies have also been divided into classes, 
which have received names denoting the principal effect pro- 
duced, or the particular organ on which they mostly act, as, 

Emetics, or medicines which occasion vomiting. 

Nauseants, such as produce a less degree of sickness than 
will produce vomiting. 



INTRODUCTION. XXV 

Cathartics, or medicines which purge the bowels ; and 
these are said to be active or drastic when they occasion 
very copious or profuse discharges ; and aperient or laxative 
when the effect is mild and gentle. 

Diuretics are such medicines as increase the flow of urine. 

Emmenagogues are remedies which excite the menses or 
courses. 

Diaphoretics, such means as promote increased secretion 
from the skin, as in sweating; and these are also called 
sudorifics when the action is very powerful. 

Expectorants are such medicines as excite a discharge 
from the lungs and throat, by increasing the natural secre- 
tions of these parts. 

Sialogogues are medicines which increase the flow of 
saliva or spittle. 

Sternutatories, such as excite the secretions of the nose 
or nares. 

Hydragogues are medicines which occasion an increased 
discharge of water or serum, as from the bowels or 
kidneys. 

Cholagogues are medicines which produce a flow of bile, 
as the mercurials. 

Anthelmintics are such means as expel worms. 

Antacids are such as neutralize or destroy acids in the 
stomach or bowels. 

Absorbents are such medicines as combine with and 
render inert acrid matters in the stomach and bowels, as 
chalk, charcoal, etc. 

All these are more or less local in their effects upon 
certain organs or parts. There are other remedies which 
produce a general effect upon the whole system, as, 

Astringents, or such medicines as cause an increased con- 
traction of the tissues or fibres. 



XXVI INTRODUCTION. 

Tonics, or those which give strength or tone to the 
system. 

Corroborants, which mean nearly the same thing as tonic, 
viz., strengthening, invigorating. 

Antiseptics, or medicines which resist putrescency, or a 
tendency to gangrene or decomposition, as the acids, and 
most of the essential oils. 

Stimulants, or such means as increase the activity or 
force of the circulation of the blood. 

Nervous Stimulants are remedies which excite a more 
vigorous condition of the brain and nerves. 

Narcotics are means which depress nervous influence, 
and destroy consciousness and sensibility, as opium, hen- 
bane, etc. 

Sedatives or Anodynes are such remedies as relieve pain 
and allay nervous irritation without producing unconscious- 
ness, such as assafoetida and hops. 

Antispasmodics are nearly the same as sedatives, but the 
term is particularly applicable to such means as prevent 
spasm and soothe nervous irritation without occasioning 
stupor or any disposition to sleep, as musk, castor, e,tc. 

Anaesthetics, or such means as destroy sensation, as chlo- 
roform, ether, etc. 

Alteratives, or such remedies as produce a gradual change 
in the condition of the system, as iodide of potassium. 

Attenuants, such as occasion a thinness of the blood. 

Disobstruents or detergents, such medicines as cleanse the 
system from impurities ; and, lastly, 

Alimentives or dietetics, or such means as nourish or build 
up the system, as food and drink. 




FRONT VIEW OF THE ADULT SKELETON. 



MEDICAL ADVISER. 



FEVER. 

CHAPTER I. 
fever: its nature and phenomena. 

Febrile diseases have, in every age and country, formed 
the principal outlet of human life. Sydenham estimated 
that in his day two-thirds of the human family died of 
fevers. At this time, I suppose the mortality from this 
cause is not so great ; perhaps not more than one-half now 
die of fevers. But this is sufficient to give the subject 
paramount importance ; and any plan which would mate- 
rially lessen the mortality, we would reasonably suppose, 
would be seized on by every one who had a spark of phi- 
lanthropy in his composition. 

Suppose a plan were adopted which would stop this 
outlet to human existence : it would save in one year, in 
these United States alone, at least half a million of lives ; 
a number greater than the entire population of America at 
the beginning of the last century. But a plan which 
would save half of this amount would in all fairness 
entitle the discoverer to be classed among the prominent 
benefactors of mankind. And this, yes, more than this, I 
profess to have discovered, and propose to explain. I will 

(25) 



26 on fever: 

not only speak of the means used, and present the evidence 
of their success, but trust that I shall be able to prove, by 
sound philosophical reasoning, that there is a fitness be- 
tween the means and the end ; and that the remedies ought 
to do exactly what I have proved by experience that they 
will perform. But whether this important discovery will 
be duly appreciated, is yet to be ascertained. 

I am aware that we are all slow to acknowledge any 
thing to be great which is the work of a contemporary, and 
especially of a fellow-citizen and an equal : it requires the 
charm of distance, of time or space, to throw around any 
great discovery that prestige wmich commends it to our 
acceptance. 

In order to a correct understanding of any derangement 
in complicated machinery, it is essentially necessary to 
possess a thorough knowledge of its construction, and the 
philosophy of its operations. With regard to the mechan- 
ism of the human system, and the manner of its natural 
movements, I must refer the reader to systematic works 
on anatomy and physiology ; I can only here give a gene- 
ral summing up of a few of the most important points. 

For example, w T e have the osseous [bony] system, form- 
ing the framework ; the fibro-cartilaginous system, to invest 
the bones and tie them together; the muscular, whose 
office it is to act upon the bones and other parts, and put 
them in motion ; the glandular system, to prepare material 
for ingress and excretion ; the circulatory, by which mate- 
rial for reparation is carried to every part, and the worn-out 
particles conveyed from every part ; the cerebrum, [upper 
brain,] where thoughts are manufactured and sensations 
recognized ; the organs of sense, which serve to put this 
thinking apparatus into connection with the world ; the 
cerebellum [lower brain] and its spinal prolongation, where 
motive and other powers are generated for propelling all 
this complicated machinery; the nerves, which serve as 
electric wires to transmit intelligence or influence to the 
great mental or sentient emporiums,, and return the proper 
responses ; then we have the cuticular [skinny] system, 
which forms a covering for the whole, and a lining for all 



ITS NATURE AND PHENOMENA. 27 

the hollow viscera which have an external opening; and, 
lastly, we have the cellular system, which serves the im- 
portant purpose of connecting all the other parts together, 
of filling up irregularities and unoccupied spaces, and giv- 
ing to the whole the proper form and pleasing contour 
which is presented by a well-developed human body. 

Now, in order that we may have a perfect manifestation 
of the phenomena of life, all these parts must be fully 
developed, and in a healthy condition, and each perform its 
function well. It is evident that if any part be preter- 
naturally developed, or act with unwonted power, a loss of 
harmony must be the consequence, and the whole ma- 
chinery be caused to work imperfectly or unnaturally. If 
all should work with increased power, we would certainly 
have a high development of the phenomena of life ; and if 
all should act with diminished energy, we would have a 
weaker development of life ; but so long as there remained 
harmony of action between the various parts, in neither 
case would we have disease. I wish to impress this parti- 
cularly upon your attention, for some important inferences 
will be drawn from it. I therefore reiterate, that neither 
increased nor diminished action constitutes disease, so long 
as there is harmony maintained between the various organs. 
Example : take a young man whose system is fully de- 
veloped ; place him under the influence of the various ex- 
citants addressed to each organ and sense ; let his stomach 
be stimulated by the most savory food and exhilarating 
viands ; his hearing enraptured by exciting music ; his 
smell regaled by the most delicious odors ; his eyes wander 
over a galaxy of captivating beauty ; his touch vibrate to 
the magic influence of contact with the embodiment of 
female loveliness ; his muscles strung to their highest tone 
by the whirling dance ; his sexual orgasm thrilled by the 
uncovered developments of feminine charms ; his intellect 
excited to its highest capacity by sallies of wit, sentiment 
and humor from his bewitching partner. Look at him ! 
His eye flashes light; intelligence and zest of enjoyment 
beam from every feature ; his whole form is full from cen- 
tripetal action ; his step is as elastic as the steel bow ; his 



28 on fever: 

heart beats vigorously; and sends the red current coursing 
through the minutest vessels. Is he sick? He never 
could feel better. But will not disease ensue from this 
state of excitement as a consequence ? It may, or it may 
not. If his stamina is good, if his organs are well balanced, 
this state of high excitement may be indulged in a thousand 
times with impunity; but if there should be some weak 
point, some imperfectly .developed organ, it may suffer 
under the pressure, become exhausted by the excessive 
tension, and afterward be incapable of performing well its 
part ; disturbance in the play of the machinery of life be 
the consequence, and disease be set up, more or less danger- 
ous in proportion to the importance of the suffering organ 
to the continuance of life. By this disturbance in the play 
of the vital forces, resulting from the broken harmony 
among the organs, some are thrown into increased action, 
but others are debilitated. There is never general increased 
action ; for then would there be harmony in the working of 
the machinery, and a high state of life would follow, and 
not disease. But it is philosophically certain that no one 
organ can act with unusual power for a considerable length 
of time without exhausting its energies, and occasioning 
subsequent debility in itself; and also, by breaking up the 
harmony, and calling upon, the general supply for more 
blood and more vital influence than are allotted to it, either 
the whole system must feel the shock, or, what is more 
common, some other organ, from accidental or constitu- 
tional weakness, will suffer in particular. I grant that 
increased action in any one part does not, in itself, consti- 
tute disease ; it is only when over-action has produced 
debility in itself, or some other important part, that disease 
may be said to commence. This, them narrows down the 
matter to a single point, that disease consists in debility in 
one or more organs, and that there can be no disease with- 
out debility ; and that this debility must of necessity be 
partial. A general feebleness does no more constitute 
disease than general power. The machinery may be quite 
fragile ; have but little momentum ; afford but feeble resist- 
ance ; but as long as there is correspondence among all its 



ITS NATURE AND PHENOMENA. 29 

parts, there will be harmony of its movements. So of the 
human system : so long as the various organs work in 
harmony, so long there can be no disease. The individual, 
though capable of little mental effort, of trifling muscular 
exertion, having weak perceptions, and small manifestations 
of desire or passion, yet has a feeling of well-being; has 
neither pain, nor sickness, nor fever, nor any other mani- 
festation of disease ; and this will continue to be the case, 
though the powers of life should continue to become more 
and more feeble, until the machinery stops its motion. We 
would then have a case of natural death, but not a case of 
disease. 

This view of the nature of disease in general forms the 
key by which I propose to unlock the mystery of the 
febrile movement in all its forms, and it is upon the theory 
based upon this platform that I have built a mode of prac- 
tice which has succeeded in my hands, and in the hands of 
many others, in divesting this formidable family of maladies 
of nearly all its terrors. But I am not content with know- 
ing that I can abort all the forms of fever common in our 
country. I wish to know how the thing is done, and to be 
able to point out a philosophical adaptation of the means to 
the end. I beg indulgence, therefore, for being a little 
tedious in the defence and illustration of the first principles 
upon which my plan is founded, and I hope the reader will 
ponder them carefully. 

I repeat, that all disease is dependent on, and has its very 
existence in, debility ; general disease arising from debility 
in some general tissue or system of organs ; local disease, 
from debility in one or more of the structures of which the 
part affected is composed. For illustration, I will refer to 
a familiar example, viz., local inflammation of the cellular 
tissue. From observations made under the inspection of 
the microscope, the following phenomena have been observed 
to follow the application of stimuli or irritants to any part 
suitable for observation — increased action of the capillary 
vessels, and increased momentum of the blood ; and if the 
irritation be now removed, the parts soon return to their 
natural condition, showing clearly that disease or disordered 



30 on fever: 

action does not necessarily follow increased action. But if 
the stimulation be continued, the capillaries soon have their 
vitality so much exhausted that they fail to respond to it, 
but, on the contrary, dilate mechanically to the expansive 
force of the blood, admitting a much larger amount than 
usual, which flows on slowly and sluggishly; and if the 
stimulation be now increased, instead of quickening the 
action of the vessels, they become entirely torpid from ex- 
haustion, and the blood stagnates and presents the well- 
known phenomena of gangrene. Carpenter says : " If whilst 
we watch the movements of blood in a companion artery 
and vein, we draw the point of a fine needle across them 
three or four times, without apparently injuring them or the 
membrane over them, they will both presently contract and 
close ; then, after remaining for a few minutes in a con- 
tracted state, they will begin again to dilate, and will gradu- 
ally increase in diameter until they acquire a larger size 
than before the stimulus was applied. When in this condi- 
tion, they will not again contract on the same stimulus as 
before ; the needle may now be drawn across them much 
oftener and more forcibly, but no contraction ensues, or only 
a trivial one, which is quickly followed by dilation : with a 
stronger stimulus, however, such as that of great heat, they 
will again contract and close, and such contraction may 
continue more than a day before the vessels open and per- 
mit the blood to flow through them." We see, then, that 
notwithstanding the pain, soreness, swelling, throbbing, all 
seem to indicate over-action in inflammation, it is neverthe- 
less essentially a disease of debility ; and all these concomi- 
tants can easily be accounted for consistently with that fact ; 
more than that, they all grow out of it, are produced by it. 
The redness is the consequence of the accumulation of blood, 
which we have seen is occasioned by the debility of the 
vessels, causing them to yield to the pressure of the blood. 
This engorgement produces the swelling ; it also causes the 
pains ; for the nerves in the coats of the vessels are neces- 
sarily stretched by the enlargement, and those in the inter- 
mediate cellular tissue are necessarily compressed, and of 
course pain and soreness are the consequence. The engorge- 



ITS NATURE AND PHENOMENA. 31 

ment also occasions the throbbing ; for the blood, not finding 
a vent through the capillaries, is accumulated in the small 
arteries, and a concussion more or less powerful in propor- 
tion to the heart's action is felt during every pulsation. 
The obstruction also causes the heat : any of you can at 
once prove to yourselves that a simple obstruction to the 
circulation of the blood causes heat, by drawing a ligature 
around any of your extremities, so as to obstruct the return 
of the blood. 

The rationale of the curative means most relied on for 
subduing inflammation, also goes to establish this view of 
its nature : 

1. Equable pressure obtained by the roller bandage, by 
which the quantum of blood flowing to the part is lessened, 
and the coats of the vessels supported, and thus enabled to 
react and assume their former size. 

2. The application of cold and other astringents, which 
produce the same effect in a different mode. 

3. Stimulation, by which the vitality of the capillaries is 
aroused, and they made to contract upon their contents. 

A stimulus of a different kind from that which produced 
the debility, or even a milder application of the same kind, 
will often prevent an inflammation, or speedily arrest it 
when set up. Example, a frozen extremity : the applica- 
tion of ice-water will often restore the suspended animation ; 
and it is well known that a degree of heat a little less than 
produced a burn will " draw out the fire," in common par- 
lance; that is, it prevents the inflammation which would 
otherwise follow. Spirits of turpentine, camphor, and other 
stimulants, act upon the same principle. We all know the 
efficacy of cayenne pepper in subduing inflammation of the 
throat; of creosote, oil of cloves, etc., for allaying inflam- 
mation of a carious tooth; of strong alcoholic spirits for 
alleviating mercurial inflammation of the mouth, or for 
superficial erysipelas. But why multiply examples ? The 
common sense of mankind has in all ages led them to cure 
inflamma,tion by stimulation. But, says an objector, how 
will you account for the soothing effect of emollient poul- 
tices, upon this view of the subject ? Very easily. The 
3 



32 on fever: 

tension of the parts causes the pain, and the irritation ol 
the pain causes an increased flow of blood to the part; the 
poultice relaxes the skin and subjacent cellular tissue, en- 
abling them to yield to the pressure of the engorged capilla- 
ries, thus taking off the pressure from the nerves which 
caused the pain ; less blood flows to the part, as a conse- 
quence, and the inherent vitality of the capillaries, return- 
ing, enables them to resume their usual calibre and regain 
their natural action in circulating the blood. 

Perhaps it would be well for me here to make a few 
observations upon what I mean by the capillaries, and their 
office. You no doubt have been already taught that they 
form the connecting link between the arteries and the veins ; 
they also are the secretory vessels which separate the 
various materials intended for the use of the system, or 
for excretion from the system ; they also separate from the 
blood the material for building up the system in its various 
parts ; also separate the worn-out particles from the various 
tissues, and convey them into the veins or lymphatic 
vessels, to be forwarded to the appropriate organs of excre- 
tion. In short, the capillaries do every thing that is done 
in the way of building up or taking down the system. 

But to return. Having shown that inflammation is essen- 
tially a disease of debility, it will be easily demonstrated 
that fever is also ; for fever is, "to all intents and purposes," 
an incipient inflammation. Common observation indicates, 
and the microscope demonstrates, that the condition of the 
capillaries in fever, and the first stage of inflammation, 
is identically the same. We have but to observe the 
phenomena of a case of fever, and analyze the symptoms 
as they consecutively occur, to become assured that 
this, as well as inflammation, has its foundation in debility 
— begins in it, continues with it, and sinks under it, 
or ceases with its removal. Let us, for illustration, take 
a case of common symptomatic fever, and consider its 
cause, its inception, its development, and its cessation, 
and see if we cannot show up the footprints of debility 
throughout its entire march. A boy runs heedlessly 
over rocks, and bruises his heel; inflammation, and, of 



ITS NATURE AND PHENOMENA. 33 

course, swelling, ensue ; but the hard integument will not 
yield, and the consequent pressure upon the nerves, with 
wmich the part is abundantly provided, causes intense suffer- 
ing ; and the cellular tissue, being here dense and fibrous, 
suppurates slowly, so that the case is protracted long 
enough for the painful impression carried b}^ the nerves to 
their spinal origin to stimulate that organ so as to occasion 
debility in its structure ; which, as in incipient inflammation, 
is attended with engorgement of the capillaries which enter 
into its composition, causing a retarded circulation of the 
blood through its vessels ; the nervous matter is pressed by 
the distended vessels, and its energies cramped, so that it 
sends out deficient or morbid nervous influence, which is 
manifested as follows : The boy feels listless, weak, and 
mopish ; complains of aching in the back and limbs, soreness 
of the flesh, and rigidity of the muscles, which make him 
averse to move ; the organs of secretion work languidly 
and unnaturally ; there are fitful sensations of heat and 
chilliness ; his appetite is capricious, feeling hungry, but 
refusing food when presented ; his heart beats languidly, 
or rapidly with a weak and variable motion ; the congested 
capillaries give a duskiness to the surface ; his eye is watery, 
weak, and lustreless, and his intellect clouded. But the 
blood, not finding a ready passage through the congested 
capillaries, necessarily accumulates in the large vessels ; 
the heart is soon made to feel the stimulus of distension, 
and is excited to increased action; but though it labors 
with augmented force and frequency, and throws the vital 
fluid bounding to the surface, the engorged capillaries offer 
an obstruction, and it reacts still further upon the heart. 
The patient now complains of heat, restlessness, headache, 
throbbing of the temples, dryness of the skin, mouth and 
throat, nausea, or sickness of the stomach ; in short, of all 
the distresses usually attendant on a well-developed case of 
fever; every feeling, every sensation is unnatural; every 
function is deranged ; every secretion is morbid. 

Here let us pause a moment, and consider the real condi- 
tion of our patient. Has he too much blood in his system ? 
Not an ounce more than he had a few hours ago, when he 



34 ON FEVER : 

was laboring under the period of depression. Is his blood 
charged with some poisonous matter that is fretting the 
heart into this tumultuous action ? It is the same blood 
that flowed tranquilly through his veins a few nights since, 
when he slept as quietly as an infant, and breathed so 
softly that a feather would not have quivered from its force ; 
the same that, in his waking hours, gave buoyancy to his 
feelings, and filled him with the zest of young life's enjoy- 
ment. There is, then, not too much blood ; neither is his 
blood poisoned ; but it is obstructed in its circulation ; and 
the proper method of relief is, not to lessen' its quantity, 
nor to purge away part of its constituents, but to stimulate 
the capillaries, restore their vital activity, make them con- 
tract upon their contents, and thus remove the obstruction 
to the onward current of the blood ; and the heart being 
relieved from the stimulus of distension, and the nervous 
matter from the stimulus of compression, all the over- 
action will quietly subside, all the morbid sensations will 
disappear, and the machinery of life run on smoothly 
again, without having sustained any loss of power by the 
means that have been used to set it right. But the first 
consideration in this case should be to remove the cause ; 
for, while it is still operating, it will be very difficult to 
keep down the effects. Every one would agree that the 
abscess should be opened to relieve the tension, and poul- 
ticed to allay the irritation ; and then, if the system had 
been previously healthy, it will perhaps return again by its 
own inherent powers to its former state of well-being. 
And, I presume, it will be conceded that it would be just 
as important to remove the cause in every other form of 
fever as in this, if it could be done ; and I hope to be able 
to show that the cause of at least some other fevers can be 
as certainly and as speedily destroyed as the one we have 
considered. 

But to progress with the matter immediately under con- 
sideration ; that is, that all fevers are dependent on debility. 
The next most appropriate form of fever that presents, 
itself for illustrating this position, is child-bed or puerperal 
fever. In this case the whole system has received a severe 



ITS NATURE AND PHENOMENA. 35 

shock : there has been exhausting muscular effort, severe 
and perhaps protracted suffering, and a considerable drain 
of the vital fluid — all calculated to produce general debility 
and irritability. An important organ has suffered a serious 
lesion, and its capillaries, by being debilitated, have be- 
come congested, which readily runs into the stage of actual 
inflammation. The already excited uterine nerves convey 
the morbid impression to their spinal origin, and there pro- 
duce stimulation which is felt through the medium of the 
nerves throughout the entire system. And here, at the 
commencement of this disease, we have the opportunity of 
witnessing the very first febrile movement; I mean the 
excitement felt throughout the whole system from stimula- 
tion of the nervous centres. Who, that has had experience 
in puerperal fever, has not marked that, just before the 
onset of the disease, the lady felt unusually ivell? She 
enjoyed with a zest the society of her friends ; dallied 
with her infant ; took nourishment with a relish ; and was 
buoyant under the confident anticipation of a speedy re- 
covery. But important changes have been silently taking 
place : over-excitement in the nervous centres is producing 
debility, and the debility engorgement ; the first manifesta- 
tion of which, perhaps, is, that the lady complains of feel- 
ing tired, and falls asleep, from which she is aroused by 
regular rigors. The whole system now feels the shock; 
the head, back, and limbs ache ; the heart beats laboriously; 
the lungs play with difficulty, and there is restlessness and 
sighing ; but the blood soon accumulates in the great ves- 
sels, so as to excite the heart by the stimulus of distension 
to increased action, and the blood is sent with power to the 
periphera ; but the weakened, torpid, congested capillaries 
do not transmit it freely, and hence soon follow heat, 
throbbing, pain, restlessness, and all the other concomitants 
of febrile excitement, complicated with inflammation of a 
most important and sensitive organ. All this is very un- 
expected to friends who were misled by the deceptive 
excitement of the first stage, and all are ready to give a 
reason. She was too smart, they say ; sat up too much ; 
talked too much to the baby; ate more than was proper, 



36 on fever: 

etc., etc. ; never imagining that all these were done under 
the excitement of the disease itself. 

The common sense of the profession has led it to adopt a 
plan of treatment for this disease which corresponds very 
well with the views here expressed of its nature. The 
remedies mainly relied on now are Misters to the abdomen, 
and the internal use of opium and spirits of turpentine. 
Now opium, we know, is directly a powerful nervous stimu- 
lant, and indirectly an equally powerful general stimulant, 
and turpentine is directly a most potent stimulant, only a 
little less severe than fire itself, when applied to a sentient 
or raw surface, and, hence, is much used as an application 
to burns " to draw out the fire." It does act beneficially, 
and upon the same principle that heat does ; that is, when 
a part is debilitated by the action of a powerful stimulus, 
one a little less powerful will keep up the action of the 
capillaries until they have time to regain their tone. The 
other leading agent referred to, viz., the blister, acts upon 
the very same principle : it stimulates the external capil- 
laries immediately over the inflamed organ, which, by being 
intimately associated with those within, causes them to act 
also ; just as we arrest an internal hemorrhage by dashing 
cold water upon the surface. There is, therefore, a fitness 
between these remedies and the object to be attained ; and 
the practice is, consequently, reasonably successful. But 
there is a better means for producing stimulation, which I 
will give in full in the proper place. 

The next disease which I will refer to, for illustration, is 
inflammatory fever ; and I should suppose if I can clearly 
show this to be a disease of debility, you will find little 
difficulty in following me in the application of this term to 
all the rest of the febrile family. 

A young man, unused to active exercise, concludes to 
amuse himself with a hunt, and, shouldering his heavy 
double-barrelled fire-arm, sallies forth on a sultry afternoon : 
he sees game, but it eludes him; yet, stimulated by the 
hope of ultimate success, he pursues on, forgetful of the 
unusual tax which he is imposing upon the vital forces ; 
but, finally, his tired muscles complain so urgently, that he 



ITS NATURE AND PHENOMENA. 37 

is obliged to give heed ; and now, yielding to the ' impulse, 
he throws himself upon the ground beneath the wide- 
spreading branches of a forest tree, and drops to sleep ; on 
waking, he finds his limbs numb and stiff, and his muscles 
obey the will with difficulty ; but by an effort he reaches 
home and retires to bed. In the night he awakes out of 
unquiet slumbers, and finds his tongue parched ; his throat 
as dry as his powder-horn; his temples throbbing; back 
and limbs aching ; general heat of the surface, restlessness, 
etc. Now let us analyze these symptoms, and refer each 
to its appropriate cause. The heat and unusual muscular 
exertion produced a real, general, temporary debility, which, 
if he had returned slowly home, and retired to his own 
comfortable couch, would have subsided of itself, without 
leaving any unpleasant consequences ; but to the debility 
from exhaustion of vital energy, he superadded that arising 
from a protracted exposure to cold ; for however power- 
fully a sudden application of cold may act as a stimulus, 
its protracted influence is, most certainly, a decided debili- 
tant ; and in this case, the whole sum of vital energy having 
been lessened by exhaustion, the capillaries were unable to 
retain their tonicity, and, giving way under the onward 
pressure of the blood, became engorged beyond their ability 
to make efficient contraction. Now, this engorgement is all 
that we need to enable us to understand the why of his 
soreness, stiffness, and listlessness on waking. The cause 
was a general one, acting upon the whole system ; and the 
capillaries everywhere became debilitated and engorged, 
and everywhere produced an unnatural condition, which 
was manifested in each part according to its nature and 
office. The cerebrum is engorged, and, as a consequence, 
the intellect is dull and beclouded ; the other nervous 
centres are engorged, and the supply of nervous influence 
is deficient and of a morbid quality, causing deficient or 
morbid action in every part; the capillaries of the nerve- 
matter, of its investitures, of the cellular tissue in which 
it is imbedded, the muscular fibres, are all engorged ; and 
of course the nerve-matter everywhere is compressed and 
stretched, so that every contraction of a muscular fibre, 



38 ON FEVER : 

every change of position, causes suffering ; and even when 
the body is kept motionless, this compression and tension 
of the neuramilla are sufficient to cause that indescribable 
sensation, known as " a sense of ill-being." But, say you, 
there is no controversy here : all agree that this stage of 
fever is one of debility, but we deny that the subsequent 
one, that of reaction, is. 

Well, I will now proceed to examine it, and see if I can- 
not trace the marks of debility through it also. 

I have already alluded several times to the manner in 
which the reaction — the hot stage of "fever — is brought 
about ; viz., that the blood, by meeting with difficulty in 
its passage through the capillaries, accumulates in the heart 
and arteries, and stimulates them to increased contraction : 
now if the capillaries did not remain debilitated and inactive, 
and thus continue to offer resistance to the momentum of 
the circulation, what prevents the heart from relieving itself 
from the stimulus of the accumulated blood ? What pre- 
vents an immediate return of all the parts to a natural, 
quiet condition ? In mild cases, this desirable result often 
does take place, in consequence of a reaction of the capil- 
laries from their innate vigor, coinciding with the general 
reaction, or by the assistance of a timely exhibition of some 
of the domestic remedies, which the common sense of man- 
kind, or rather of womankind, has led them to adopt, such 
as a warm ginger-stew, aided by the stimulus of a hot foot- 
bath, etc. 

But suppose these timely remedies be neglected or prove 
inadequate : the symptoms go on increasing in inveteracy ; 
the throbbing carotids drive the blood into the vessels of 
the brain with tremendous force, but the capillaries are 
torpid, congested, and do not transmit it freely ; every 
available space is therefore crowded to the full, and the 
medullary substance [brain matter] so compressed that it 
cannot perforin its functions well ; the numerous nerves in 
its investing membrane are compressed, until they give out 
the sensation of pain, more or less intense ; association 
between the faculties of the mind is lost, and the patient 
has wild vagaries and talks incoherently : a little more 



ITS NATURE AND PHENOMENA. 39 

pressure, and mental action ceases entirely, and the patient 
sinks into coma, and is dead to all thought or sensation. 

Similar events have been taking place in other parts of 
the system; the capillaries of the stomach have been 
weakened and congested, and caused compression of the 
gastric nerves, which at first, perhaps, only gave the sensa- 
tion of hunger, but which food would not satiate; an 
increased pressure will, however, cause them to complain in 
their usual way, viz. : by nausea, sickness, and perhaps 
vomiting. The same pressure upon the nerves of ordinary 
sensation, in the coats of the stomach, causes pain and sore- 
ness. The liver suffers in the same manner : at first, 
perhaps, the congestion only increases its natural secretion ; 
a higher degree depraves it ; and a still greater suspends 
all secretion, and distends its substance so as to present an 
evident fulness externally, with more or less soreness, pain, 
and sense of weight. All the other organs suffer in like 
manner, and complain in a way suited to the office and 
sensibility of each. The skin being exposed to the imme- 
diate inspection of the eye, we are enabled to examine its 
condition more readily and more accurately than any other 
organ. Now what are the developments presented ? In 
the hot stage of fever, we see its vessels are evidently 
distended with blood, but it does not present the ruddy 
glow which we see follow active exercise in health ; but it 
is dusky, like that presented by passing a ligature around a 
limb, so as to partially obstruct the return of the blood in 
the minute vessels. 

But it may be objected that this view of the nature of 
inflammatory fever is not consistent with the known cha- 
racter of the agencies by which it is successfully treated ; 
that these are blood-letting, active purgation, nauseants, 
etc., all of which are debilitants. 

But an analysis of the modus operandi [manner of ope- 
rating] of these remedies in this particular case will show 
that their success harmonizes well with this theory. We 
will take venesection as a type of the class : it will be con- 
ceded, I suppose, that there is no actual increase of the 



40 on fever: 

quantum of blood over what was in the system immediately 
preceding the attack, or a few hours ago, when our patient 
was laboring under the period of depression; then there 
appeared to be an actual want of blood, judging from the 
pallid countenance and the shrunken surface ; there cannot, 
therefore, be too much blood, but there is an obstruction to 
its circulation, and what is wanted is not a reduction of its 
quantity, but a removal of this obstruction, so that the 
heart may be able to relieve itself without exerting such 
unusual force. This can be effected in two ways. First, 
directly by stimulating the capillaries, and causing them to 
resume their usual action in passing the blood, which, finding a 
free passage, soon relieves the heart of the stimulus of dis- 
tension, and it quiets down to its usual force of action ; or, 
secondly, the same thing can be done indirectly, by the use 
of such means as will lessen the heart's action ; for by less- 
ening the force by which the blood is pressed into the capilla- 
ries, they are allowed time to regain their usual contracti- 
bility, and resume their function. This can be done by 
abstracting blood from a vein; the supply to the heart 
being reduced, it is enabled to relieve itself of the stimulus 
of distension, and of course acts with less power ; or it may 
be done by acting upon the heart through the medium of 
the nerves : for example, nauseants and veratrum viride, by 
their depressing influence on the nervous centres, diminish 
innervation [nerve-power] generally; and less nervous 
influence being sent to the heart, and it made less sensitive 
to the stimulus of the blood, it will act with less force under 
the same amount of stimulation. 

But venesection, nauseants, veratrum viride, drastic pur- 
gatives, and all that class of remedies, relieve the obstruc- 
tion by producing positive general debility, and necessarily 
make convalescence protracted and uncertain ; whereas, by 
the first mode, that is, by direct stimulation of the capil- 
laries, relief is obtained without any loss of general strength, 
without any shock to the vital powers, and convalescence 
is consequently direct and complete. But I will dilate 
more upon this at the proper time. 



ITS NATURE AND PHENOMENA. 41 

I will now take a hasty view of miasmatic [bilious] 
fever, and see how well its symptoms harmonize with the 
general theory I have advanced. 

But it will amount to little more than a tiresome repe- 
tition of much that has been said, to go into a detail of its 
symptoms, and an explanation of the condition out of which 
they arise. We have here the same evidence of nervous 
and capillary debility in the forming stage which has already 
been described, with this difference : the cause having acted 
a longer time in bringing about exhaustion of vital energy, 
the manifestations of debility and morbid nervous influence 
are greater, and the functional derangement in the various 
organs is also usually more decided, so that we have, along 
with the listlessness, languor, muscular weakness, etc., 
more headache, pain in the back and limbs, greater disturbance 
of the stomach, bowels, and liver, and a more decided sense 
of chilliness. But still it must be acknowledged that the 
symptoms of the first stage of all fevers, whether sympa- 
thetic, malarial, or contagious, are so nearly similar that the 
most experienced practitioner, when consulted at that 
period, is often wholly unable to determine what form it 
will assume when fully developed. And, fortunately, it is 
generally of the least possible consequence that he should 
determine, provided he have a clear comprehension of the 
condition of the system out of which the symptoms have 
grown : a hot mustard foot-bath, frictions along the spine, 
with some stimulating liniment, and a mild nervous stimu- 
lant, resorted to in this stage, will often so effectually 
arouse the capillaries, and quiet the morbid nervous excite- 
ment, that the physician is never able to learn what kind 
of a fever would have been developed, had the case been 
left unmolested. 

But to return to the case : After this stage of depression 
has continued for some time, a reaction is brought about in 
the manner already described, and differs nothing from the 
reaction in inflammatory fever, except that it is usually not 
so perfect ; for, owing to the very gradual way in which the 
stage of depression has been brought about, the debility is 
more profound, and the vital energies are, consequently, not 



42 on fever: 

so readily aroused. In some cases the exhaustion of the 
vital energies is so complete, that the patient dies in the 
stage of depression ; in others, it takes place very imper- 
fectly, not amounting to more than a mere throbbing of the 
heart, with but trifling increase of force, the extremities still 
remaining cold. But in whatever degree reaction does take 
place, it is always attended with the symptoms of capillary 
obstruction and morbid innervation ; showing that debility is 
a prominent feature of this stage also. Perhaps there is no 
one fact connected with this stage that points so conclusively 
to debility as constituting its most prominent character as 
this, that notwithstanding the reaction , there is no increase 
of strength : on the contrary, the more powerful the heart's 
action, the more utter is the feeling of prostration ; unless, 
indeed, the brain becomes maddened by inflammatory action, 
causing frenzied demonstrations of power. After this state 
of excitement has continued for some hours, it begins to 
abate, and we have an intermission, or at least a remission, 
which appears to be brought about in the following manner : 
The heart, being nothing more than a great muscle, is sub- 
ject to the laws governing muscles in general. One of these 
is, that when they are made to contract with more force 
than usual, they become tired, or have their vitality ex- 
hausted. Accordingly, the heart, after acting with unusual 
power for a few hours, becomes weary, and gradually as- 
sumes a more moderate action, under the same amount of 
stimulus ; and besides, the capillaries react in some degree 
during the excitement, and, by passing the blood on, lessen 
the stimulation of the heart. But there is still another way 
in which a remission, or at least a subsidence of actual 
excitement, may be brought about. At the termination of 
each capillary, whether it communicates with a vein or an 
absorbent, or opens into an excretory duct, or performs a 
secretory office, or opens externally through the skin or into 
the bowels, there resides a peculiar sensibility which acts 
as a kind of sentinel over the passage of the contents, and 
refuses to allow any constituent of the blood to pass, except 
that which nature designed to pass. But in cases of great 
debility this guard leaves its post; in other words, the 



ITS NATURE AND PHENOMENA. 43 

sensibility becomes so deficient, that the mouths of the 
capillaries relax so as to suffer the more fluid parts of the 
blood to pass out unchanged and unchecked, and a wasting 
colliquative sweat or diarrhoea lessens the heart's action, and 
at the same time wastes the energies and resources of the 
system. 

If the intermission be perfect, and the vital energies of 
the system not much exhausted, the system regains nearly 
its usual healthy condition, the sensations become more 
natural, and the secretions more or less restored, showing 
clearly that debility was the cause of both inaction and 
reaction. But the cause is still in operation, and the capil- 
lary inaction only partially removed ; and, after a certain 
period, another paroxysm is set up in the same way as the 
first. Now, in case the debility in the capillaries is greater 
and more persistent, in place of a perfect intermission suc- 
ceeding the reaction, there will only be a remission ; and 
this will be more or less perfect, exactly in proportion to 
the degree in which the capillaries can be aroused by the 
stage of excitement. 

Now, all will be ready to admit that the lowest cases, 
such as prove fatal in the first stage, and such as are at- 
tended with a feeble reaction, are characterized by debility. 
Well, according to the fair analysis which has been given 
of the various stages of fever, it is plain that these lowest 
cases are founded in the very same morbid changes which 
gave rise to the slighter and most open forms ; the only 
difference being the greater intensity of the debility occa- 
sioned by a more powerful action of the remote cause, or 
from its acting for a longer time, or on a system debilitated 
by some other cause. 

I will now hastily sum up what I think have been proved 
to be the essential circumstances connected with, and con- 
stituting, a case of fever. 1st. Morbid impressions made 
upon the nervous centres. 2d. Weakened and vicious 
nervous influence sent out through the whole system. 3d. 
That this weakens the action of the capillaries, and causes 
them to dilate under the pressure of the blood, while, at 
the same time, the sensibility of their mouths is so altered, 



44 on fever: 

by having been supplied by morbid nervous influence, that 
they refuse to let the blood pass ; just as the neck of the 
bladder, when irritated, refuses to give passage to the 
urine, though of a natural quality, thereby retarding the 
blood in the capillaries, and obstructing the circulation. 
4th. That the accumulation of blood in the large vessels, from 
this cause, occasions the heart and arteries to be unduly 
excited by the stimulus of distension, thus producing the 
reaction which constitutes the hot stage. 5th. The pres- 
sure and tension occasioned by the engorgement of the 
capillaries, give rise to all the unnatural phenomena which 
attend a case of fever throughout its several stages, viz., 
the increased, depraved, or suspended secretions, painful 
and unnatural sensations, inflammatory complications, etc. 
6th. It is only by a partial restoration of the natural action 
of the capillaries that an intermission, or remission, is ob- 
tained ; and only by permanently restoring this action can 
the disease be broken up. And, lastly, if capillary action 
is not restored, the patient dies. 



CAUSES OF FEVER. 45 



CHAPTER II. 

CAUSES OF FEVER. 

We now have but one more point to examine, and we 
will then have a plain, practical, common-sense view of the 
whole subject ; that is, the original cause, the agency by 
which the deleterious impression is made upon the nervous 
centres. In symptomatic fever, we know that the remote 
cause is morbid impression sent by a suffering organ to the 
brain and its appendages. The remote cause of inflamma- 
tory fever is known to be the depressing influence of a 
protracted exposure to cold upon a system exhausted by 
fatigue ; but the remote cause of other idiopathic fevers is 
not so well understood, but it is certain that it must be 
something that is capable of floating in the atmosphere, 
and that it is either organic or inorganic, and that it either 
acts upon the nerves of the sentient surfaces, as the skin 
and alimentary canal, or it enters the circulation and acts 
immediately on the nervous centres. Now, it does not 
appear to be reasonable to suppose that it acts primarily 
upon the surfaces ; for then those parts should first show 
signs of disease before they could send morbid impressions 
to the nervous centres, so as to bring about the debility 
which characterizes the first stage of all fevers. But we 
know that there is no previous manifestation of irritation 
in these surfaces ; then the cause must enter the circula- 
tion, either through the lungs or along with the ingesta, 
[food,] and reach the nervous centres through the blood, 
and, when there, act either as a mechanical irritant or a 
narcotic stimulant. My views of the whole subject are 
briefly as follows : That the cause of all malarious epidemic 



46 ON FEVER : 

and contagious fevers is organized existences — infinitesimal 
animalcules or sporules which float in the atmosphere, and 
are inhaled with it into the lungs, and, permeating the 
lining of the air-vesicles, enter the blood, and by it are car- 
ried to the nervous centres, where they act as narcotic 
poisons. 

This view of the subject will enable us to explain many 
of the facts connected with the spread of febrile diseases, 
which no other theory can. It also enables me to give a 
rational explanation of the mode in which one of the reme- 
dies which enter into my plan of treatment operates in 
arresting fevers, which I otherwise cannot explain. But 
whether, organic or inorganic, it most certainly acts as a 
narcotic stimulant, or nerve poison : the nature of the first 
symptoms indicates this most unmistakably. 

Fordyce says : "One of the symptoms of fever is dimi- 
nution of the sensibility of the skin ; of this, one great 
instance is its insensibility to heat, which has been so great 
in some instances that no sensation has been impressed on 
the mind when hot bodies have been applied so as to coagu- 
late the scarf skin. This insensibility to heat is not from 
the sensation of coldness, for it extends to the sensibility 
of the skin of every kind ; it is a degree of what is called 
numbness, or indistinctness of the ideas which are obtained 
by the feel of the figure of bodies, their smoothness or 
roughness, their hardness or softness, etc. It is extended 
to other means that give pain, as stimulating applications, 
the pricking of sharp instruments, etc. The degree of 
this numbness or want of sensibility of the skin takes 
place in various degrees, but exists in almost every case 
of fever." He also describes as common, "a sense of 
weight, fulness and uneasiness about the breast and pit of 
the stomach, similar to what is produced by fear, grief, and 
other depressing passions." 

Persons sometimes die in the first stage of fevers, and 
the symptoms show that the cause of death was purely a 
powerful nervous impression. Fordyce says : "When the 
first attack is fatal, it sometimes kills in less than five min- 
utes ; sometimes it requires half an hour, seldom a longer 



CAUSES OF FEVER. 47 

time. While the patient is yet sensible, violent headache 
with great sense of chilliness takes place ; the extremities 
become very cold and perfectly insensible ; there is great 
prostration of strength, he becomes pale, his skin is of a 
dirty brown, and he is soon insensible to surrounding ob- 
jects," etc. He adds, that "when in any paroxysm of 
fever rigor and horror take place, the patient is never car- 
ried off by that paroxysm." The reason of this is obvious : 
these rigors are evidence that the nerves are not totally 
overwhelmed. When reaction takes place in the nervous 
system, there is great exaltation of sensibility ; hence the 
patient complains greatly of heat, although the actual heat 
of the body may not be greater than in health, or even 
much less. Fordyce says upon this subject: "The heat 
over the whole body seems intense to the patient ; yet, upon 
the application of the thermometer, it is found even less 
than it was when the patient felt himself cold." This ex- 
altation of the sensibility also accounts for the extreme 
restlessness experienced by patients in this stage. The 
reaction of the heart sends the blood with force to the ca- 
pillaries, but they, being debilitated, do not transmit it 
freely, and become distended so as to press upon the inter- 
stitial nerves, whose sensibility is now greatly augmented, 
giving that indescribable sense of suffering and restlessness 
all have experienced who have endured the hot stage of a 
paroxysm of fever, producing a sense of "prolongation of 
time," so that a minute will appear an hour, and an hour 
an age. Fordyce further says : "It happens often, at the 
beginning of an attack of fever, that the patient has a sen- 
sation as of some light body moving over the hairs that 
arise from the skin, as if, for instance, a number of little 
insects were walking the points of these small hairs." The 
above is exceedingly suggestive of the nature of the cause 
of fever, for what but a narcotic could produce this pecu- 
liar sensation ? All who have taken opium will recognize 
this description as answering admirably for the sensations 
occasioned by that drug, the impression of insects running 
over the surface being often very distinct and very annoy- 
4 



48 on fever: 

ing after being narcotized to a certain extent, or fully im- 
pressed by alcoholic potations. 

That the cause of fever, be it what it may, acts primarily 
upon the brain and appendages, has been fully acknowledged 
by the best authorities. Dr. Smith says : "The immediate 
cause of fever is a poison which operates primarily and 
specifically upon the brain and the spinal cord. The 
diseased state into which these organs are brought by the 
operation of this poison, deprives them of the power of com- 
municating to the system that supply of stimulus (nervous 
and sensorial influence) which is required to maintain the 
functions of the economy in the state of health." A super- 
abundance of authority could be arrayed in support of the 
position that the impression is first made upon the brain 
and nerves, but no one appears to have been led to perceive 
that this impression was that of narcotism ; but still, with- 
out having this idea before the mind, authors, as above, in 
describing the manifestations of the operation of this poison, 
have unknowingly traced out a good description of the 
effects of narcotic stimulation. This point being settled, 
the field of investigation is at once open for means to neu- 
tralize the poison or counteract its effects. 



TREATMENT. 49 



CHAPTER III. 

TREATMENT OF FEVER. 

I have now dwelt long enough upon the cause of fever, 
its nature and phenomena, and have doubtless convinced all 
whom I shall be able to convince, that the theory I have 
offered is the true theory. I will, therefore, leave this part 
of the subject, and proceed to give the plan of treatment 
which has grown out of these views, and which in my hands 
has proved successful beyond any parallel of which I am 
informed. 

According to the foregoing views, there are four points to 
be met in the treatment of every case of fever : 

1. To remove the cause. 

2. To allay the nervous disturbance. 

3. To restore the action of the capillaries. 

4. To allay over-action and equalize the circulation. 
And first : to remove or neutralize the remote cause. 

In symptomatic fever, it is obvious that our first efforts 
should be directed to the removal of the local irritation 
which has given rise to it. If it be from a protruding tooth, 
we should remove the tension of the investing membrane 
by dividing it. If worms in the alimentary canal, expel 
them. If local inflammation, use such means as will assuage 
it, etc., etc. The same thing should be done in idiopathic 
fevers — that is, those which are produced by the direct 
action of the remote cause upon the nervous centres ; for as 
long as the cause is still acting, it will still keep up the 
effect. But how is this to be done ? It had never been 
attempted, so far as I am informed, until I attempted it. 
Having come to the conclusion that the cause of all idio- 



50 on fevers: 

pathic fevers is a something possessing the property of a 
narcotic poison, I believed that the oil of sassafras would 
destroy or counteract, or neutralize it. I had tried it for 
these purposes a thousand times, successfully, in other 
analogous cases. For example : I had tried it repeatedly 
for destroying insect life, and found it immediately fatal to 
every kind ; had also tested its powers upon the infusoria 
in impure water, and saw it destroy them instantly. I 
therefore felt assured that if the cause was really the pre- 
sence of minute animalcules disturbing the nervous centres, 
this would be conveyed by the circulation in sufficient 
strength to destroy them at once. I also knew that it 
would as certainly destroy or neutralize any poison wdiich 
they might have infused into the system, for I had tested 
its power fully in destroying the poison of insects and 
reptiles, such as mosquitoes, fleas, spiders, bees, wasps, 
etc. ; and, on one occasion, had an opportunity of testing its 
powers over the venom of the snake known as the copper- 
head, and found it to succeed promptly. I also knew, from 
repeated experiments, that it w^ould destroy or prevent the 
effects of vegetable narcotics, such as tobacco, henbane, etc. ; 
I therefore judged that, should I be mistaken in the cause 
of fevers being animalcules, it must of course, then, be a 
poisonous gas ; and believing, from observing its effects, 
that it must be of the narcotic kind, I had good reason to 
infer that the oil of sassafras would succeed, should this be 
the case. I therefore expected it would meet the first in- 
dication, and was not disappointed. I have seen its exhi- 
bition followed, again and again, with as sudden a disappear- 
ance of the febrile movement as I ever saw follow the 
opening of an abscess, when the fever originated from that 
cause. 

The second indication, to allay the disturbance in the 
nervous system, I believed could be best met by the use of 
valerian, it having the property of quieting the nerves, 
easing pain, and procuring rest, without any of the un- 
pleasant effects of opium, and most other narcotic stimulants, 
upon the brain; having, too, no tendency to suspend the 
secretions, as they have, but, on the contrary, being a very 



TREATMENT. 51 

good diuretic, a valuable consideration in selecting remedies 
for fever, the urine always being scanty and depraved. 

The third indication, that of restoring the action of the 
capillaries, I believed could be met more effectually and 
pleasantly by the use of piperin than by any other known 
agency. I had often used it as an adjunct to quinine, in 
intermittents, and discovered that it not only produced a 
fine capillary action in the surface, but it evidently aroused 
the capillaries everywhere, as all the suspended func- 
tions were usually restored without the aid of any other 
means. I liked it because, although it produced a fine 
action on the surface, it rarely excited perspiration ; on the 
contrary, checked it when present, if of the passive kind. 
It is also recommended by the fact that it is borne well by 
the stomach, and has a good effect in quieting the nausea, 
so often distressing to the patient in fever. Its cousin, 
cayenne pepper, is of too fiery a nature to be borne well by 
the stomach, or readily imbibed by the absorbents ; the 
piperin has, in my hands, answered the purpose so finely, 
that I have had no reason to desire a better remedy. 

The fourth indication, that of quieting the heart's action, 
and equalizing the circulation, is in a great measure met by 
the means already enumerated ; for by removing or neutral- 
izing the cause, quieting the nerves, and exciting the capil- 
laries, the condition of things is removed which gave rise to 
the disturbance, and it, as an effect, consequently subsides. 
Still there are many other minor means which * may be 
appropriately called into requisition to aid the former and 
facilitate their action, such as sponging the surface with 
water of a temperature suited to the degree of general or 
local heat. For example, when the head and trunk are 
hot, and the extremities cold, apply cold water to the first, 
and hot water to the latter ; and when there is restlessness 
rather from nervous excitement than over-action, tepid 
water will answer the best. The bowels should also be 
kept moderately loose, so as to remove the debris, which is 
constantly accumulating in every case of fever. For this 
purpose I choose rhubarb, on account of its certainty of 
action, while it rarely acts too much, and, also, because it 



52 ON FEVER : 

operates without producing debility, but, on the contrary, 
is tonic and bracing in its effects. A considerable source 
of irritation in fevers is an accumulation of sour phlegm in 
the stomach and bowels, to remove which I choose sup. 
carb. of soda. I also found much advantage from friction 
along the spine with some kind of liniment containing both 
stimulant and anodyne properties ; of course, many adju- 
vants have been resorted to, from time to time, to meet 
particular symptoms ; but the above forms a general cata- 
logue of the means by which I attempted to subdue the 
most potent enemy that has ever assailed our race, and 
with them I have succeeded, not occasionally, not generally, 
but uniformly and promptly. These means, though simple, 
as regards any unpleasant effects they can have upon the 
system, have proved as powerful in the contest with 
disease, as did the pebble which David used in his hostile 
meeting with the uncircumcised defier of Israel. 

For the sake of convenience, and to obtain an eligible 
form in which to administer the remedies, I formed them 
into a syrup after the following formula : Take half a pound 
of common rhubarb-root, and after breaking it coarsely, add 
half a gallon of water ; place it over a slow fire, and keep 
it near the boiling-point for three hours, then strain ; there 
will now be about a quart ; to this acid five pounds of loaf- 
sugar, and set it on the fire until it simmers ; to this, after 
it has cooled a little, add half an ounce of oil of sassafras, 
one and a half drachms of piperin, and two ounces of sup. 
carb. soda, first having rubbed them well together in a 
mortar, with a few ounces of water; stir the whole to- 
gether well, and then add one pint of saturated tincture of 
valerian. 

There are two things to be particularly remembered and 
observed in making this compound : the sugar must be the 
crystallized white sugar; if the common brown sugar be 
substituted, and the proportions used that I have directed, 
it will form a candy rather than a syrup. I have heard of 
some having made this exchange, and of charging me with 
giving a formula that was unpharmaceutical, they not 
knowing, I suppose, that crystallized white sugar, contain- 



TREATMENT. 53 

ing so much more water of crystallization than the brown, 
requires a smaller amount of water to give it fluidity. 

When I make a prescription to be rilled at a drug-store, 
I make it as follows : 

Syrup Rhubarb, ^ iv. ; Tinct. Valerian, ^ ij. ; Oil Sassafras, drops, xx. ; Pipe- 
rin, gr. x. ; Sup. Carb. Soda, gr. xx. Mix. 

The other point to be observed is, that the piperin and 
oil of sassafras must be intimately mixed with the syrup 
before the tincture of valerian is added ; otherwise the 
compound will be so pungent that it cannot be swallowed : 
after having been well combined with the syrup, the alcohol 
in the tincture does not unite with them so as to produce 
this pungency. I formerly used the infusion of valerian in 
order to avoid the pungency, but water does not extract 
the full strength of that article, and having fallen upon the 
above method of avoiding the difficulty, I now use the 
tincture in preference. Those who have seen recipes for 
making this compound which differ from this, will recollect 
this change, and also,, that in this formula there is less 
piperin and oil of sassafras, it having been ascertained that 
less of these articles would produce the effect desired. 

In the course of the foregoing observations, I referred to 
the advantage of rubbing the spine with stimulating lini- 
ments for the purpose of relieving irritation of the spinal 
marrow. Much of the suffering experienced in fever arises 
from this cause ; the back itself not only complaining, but 
pains and distress of various kinds are felt in different 
parts, which have their origin in spinal irritation, and can 
be relieved in a few minutes by the right kind of local 
application to the spinal column. I have used various com- 
pounds for this purpose, such as camphor and turpentine, 
volatile liniment, etc., but by far the best that I have ever 
tried, not only for this purpose, but also for pain or aching 
of the head, distress of the stomach, or in fact any other 
distress of whatever kind or wherever seated, so it be of 
nervous origin, is the following : 

Sp. Nit. Dulc, ^ iv. ; Aqua Ammonia, ^ i. ; Oil Juniper, ^ J; Oil Sassafras, 
^ 5 ; Gum Camphor, ^ ^ ; Chloroform, ^ i. : when the Chloroform is not at hand, 
Sul. Ether answers pretty well. 



54 ON FEVER: 

But although I give the above syrup in every case of 
fever I am called upon to treat, and in many cases give 
nothing else and do nothing else, yet, as I have before inti- 
mated, I do not always rely on it exclusively, but, in bad 
or obstinate cases, call into requisition every other means 
which I think will aid it in meeting the indications I have 
pointed out. For example : In intermittents I often give a 
dose of some strong nervous stimulant to aid the syrup to 
break up the chill ; quinine or some preparation of opium is 
preferred. After the chill is prevented, and the periodicity 
of the disease by this means destroyed, I depend upon the 
syrup alone to restore the system, and prevent a return. 
If there is so much torpor of the liver that the syrup, aided 
by a mustard-plaster to the right side, does not arouse it, I 
give a blue-mass pill every three or four hours, until I 
obtain a bilious discharge, still continuing the syrup to aid 
it, so that the effect may be obtained without mercurializing 
the system ; and if there should be deep congestion in any 
part, or actual inflammation, I apply a fly-blister, and let it 
stay until its full effect is obtained ; then have it dressed 
with an emollient poultice, without breaking the cuticle 
more than is necessary to afford an escape to the serum, 
the object of drawing the blister being to obtain a powerful 
stimulation of the capillaries during the process of drawing, 
and not to set up a drain. I therefore endeavor to get 
rid of it as soon as possible, and for this purpose apply 
soothing applications, in order to hasten the formation of a 
new cuticle, which, under proper management, is generally 
obtained in forty-eight hours. An irritable blister I dread 
as I do a salivation : both add to the debility by increasing 
the irritability of the system, and thereby retard the 
recovery. But it is not only a dread of salivation that 
causes me to be chary of the use of mercurials in fever ; I 
am equally fearful of their irritating effect upon the stomach 
and bowels, when there is any tendency to inflammation in 
these organs, or even considerable irritation. 

Consequently, I resort to mercurials only when the case 
is urgent ; and it would be surprising to those who have 
been in the habit of looking upon them as the only means 



TREATMENT. 55 

of stimulating the liver, so as to incite the secretion of bile, 
to find how much they have been mistaken. It is very 
seldom indeed that the simple means which I have laid 
down for stimulating the capillaries in general, fail to also 
excite those of the liver, sufficiently to cause it to secrete 
bile of a good quality and in sufficient quantity. But I 
do not, as I once did, expect to see my fever patients im- 
prove, as a matter of course, because I have obtained con- 
sistent bilious discharges, or that they must of necessity 
die if such are not obtained. On the contrary, I merely 
look upon the liver as one of the many organs whose office 
is essential to health. Persons may live many months 
without any secretion of bile. In fever, all the secretions 
are deranged or deficient, and health cannot be regained 
until all are restored to a natural condition ; but I do not 
look upon the restoration of the biliary secretion as of such 
paramount importance as to warrant me in being in a 
feverish hurry to accomplish it, for, as I have said, by exer- 
cising a little patience, I usually find the liver and all the 
secretory organs return to the performance of their appro- 
priate functions under the influence of the prescribed general 
treatment for restoring the action of the capillaries in general. 
I have yet said nothing about bleeding as a collateral 
aid ; I seldom bleed, yet there do cases occasionally arise 
which imperatively demand it. In cases complicated with ac- 
tive local inflammation, in which general inflammatory action 
is considerable, there is sometimes so much contraction of the 
mouths of the capillaries, that it becomes absolutely neces- 
sary to relax them by bleeding or nauseants, or both, be- 
fore a proper capillary circulation can be set up. Pleuritic 
fever and pleuro-pneumonia of a high inflammatory grade 
present good examples of such cases ; here the heart's 
action must be first partly controlled, and the spasm of the 
capillaries relaxed, before the syrup can act efficiently in 
bringing about a healthy action of these vessels. It is true 
that in such cases the convalescence cannot be so speedy 
as though no debilitants had to be used ; but if they are 
pushed no farther than is actually necessary to relieve the 
spasm, and the means then used to act directly on the 



56 



ON FEVER 






capillaries, there will only be a few days' difference in the 
time of recovery. 

The remarks which have been made apply to fever as 
a class, and are consequently applicable to all its forms ; 
it may be expected, therefore, that I now proceed to treat 
of each form particularly; but the view I have given of 
the unity of the febrile movements almost renders this 
unnecessary ; my theory embracing the conclusion that all 
the forms of fever consist in similar derangements of the 
same parts and organs, differing only in the extent or inten- 
sity of that derangement, and a tendency to affect more 
injuriously particular organs, occasioned, I suppose, by the 
remote cause acting with the greatest force upon the par- 
ticular part of the brain, or other nervous centre, from 
which the nerves supplying that part originate, or from the 
accidental cooperation of some other remote cause, acting 
at the same time upon a particular organ, as cold upon the 
surface, worms in the bowels, a determination of blood to 
the head from a debauch, disturbance of the alimentary 
canal from improper ingesta, etc. ; which, by weakening the 
vital energies of a particular part, will cause the debility 
occasioned by the remote cause of the fever to be more 
profound in that organ than in other parts, and disqualify 
its capillaries from reacting with the same facility; and 
hence, when a remission occurs, this organ does not recover 
its functional movements as perfectly as the rest, which 
circumstance has often led the observer to look upon the 
fever as originating there, and as being a disease essen- 
tially of that particular organ. But notwithstanding these 
differences and complications, all fevers consist essentially 
of the same derangements in the same parts ; and it fol- 
lows, as a consequence, that the same mode of treatment 
is equally applicable to all, only requiring such other means 
to be occasionally called into use as may become necessary 
to meet these accidental differences. This view of the sub- 
ject, you will perceive, cuts off the necessity of going into 
a detail of the treatment of particular fevers. It also 
saves the practitioner the necessity of making nice dis- 
criminations at the bedside as to the particular name of the 



TREATMENT. 57 

fever he may have to contend with — a discrimination which 
the most astute and experienced are often unable to make. 
The only call for the exercise of judgment, upon my plan, 
is to decide upon the amount of stimulation that may be 
required in any given case, in order to arouse the dormant 
capillaries, and to call into use such means as may be 
necessary to meet accidental complications. And if there 
should be any doubt as to the amount of stimulation re- 
quired, we have only to watch the effect of the medicine, 
and increase or diminish the close, according to the effect 
produced. 

But, says one, I thought you would at least go into a 
detail of your method of managing typhoid fever, as that is 
the disease which I heard your plan was particularly suc- 
cessful in breaking up. This is a mistake : it arrests and 
breaks up all the other forms of fever common in this coun- 
try, with the same promptness that it does the typhoid; 
and the only reason why particular attention has been drawn 
to this more than others, is that they are usually success- 
fully managed upon other plans, and this is not — at least, 
not aborted, broken up, and cut short in its progress. So 
firmly has the idea taken hold of the medical mind that 
typhoid fever is a self-limited disease, having a determinate 
course to run, which it will run, in spite of all efforts to the 
contrary, if the patient should live so long, that a contrary 
idea is looked upon as heterodox, and the expression of an 
opinion that it can be arrested is taken as evidence of igno- 
rance, or of a wild imagination. All of this I knew, and 
had counted the cost of, before making the announcement 
that I claim to be able to do this thing ; which odium I have 
realized in some measure, but a host of noble spirits came 
to the rescue, and now it is folly to assert that typhoid 
fever cannot be aborted. But notwithstanding that the 
general principles which have been laid down naturally point 
out the proper treatment in every fever, yet I will presently 
take up each kind, and give specific directions for meeting 
every variation. 



r 



8 ON FEVER 



CHAPTER IV. 

THEORIES OF FEVER 



HUMORAL THEORY. 

The symptoms of nervous disturbance, and of capillary 
debility and congestion, attracted the attention of the very 
earliest cultivators of medical knowledge ; but at that time 
very little was known of the office of the nerves — most of 
the phenomena connected with innervation, whether natural 
or morbid, were then referred to the workings of an imaginary 
intelligent presiding genius, called vital principle, or vis 
medicatrix natura, which, they supposed, watched over and 
regulated the operations of the system in health, and made 
efforts to restore order again when any thing went wrong. 
Of the circulation of the blood they were wholly ignorant ; 
for having confined their observations to the dead subject, 
and finding the arteries empty, and the veins full of blood, 
they supposed the latter to be the only vessels concerned 
with the blood, and, consequently, there could be no real 
circulation ; but they fancied that the blood flowed out to- 
wards the surface in the day, and back again in the night, 
similar to the ebbing and flowing of the tide. As the 
capillaries always continue their action for some time after 
the heart and arteries cease to beat, they of course pass all 
the blood from the arteries to the veins, leaving the former 
entirely empty. The ancients, therefore, not perceiving any 
other use that they could assign to these hollow tubes, sup- 
posed that their office was to give passage to the animal 



SPASMODIC THEORY. 59 

spirits. And believing that the blood was pretty much sta- 
tionary, and supposing that all diseases were occasioned by 
impurities in the blood, they imagined that the torpor of the 
forming stage of fevers was owing to the blood being clogged 
in the vessels by its impurities, and that the subsequent 
reaction was gotten up by the vis medicatrix, in order to 
throw it off, which they imagined was done by getting up a 
commotion in the blood, similar to an ebullition or fermenta- 
tion, by which the offending matter would be separated and 
cast to the surface, as syrup cleanses itself by boiling, or 
wine and cider by fermentation. The congested state of the 
capillaries they supposed was occasioned by the viscid mat- 
ter which was being thrown to the surface, and contented 
themselves to wait until the fermentation would thin it, and 
prepare it for expulsion ; consequently, all that the medical 
attendant then thought could be done, was to use such 
means as he supposed would facilitate the fermentation, or 
guard against excess, lest there should be too much stress 
upon the vessels, and occasion a rupture. 

We may now smile at their fancies, but some of the great- 
est minds that ever illuminated a human body believed 
them, and their successors for many centuries were contented 
to take them for granted. Even the great Sydenham could 
see no farther, but was evidently much perplexed to account 
for some of the facts which presented themselves to his 
observing eye upon this then established theory. Among 
other difficulties, he acknowledges himself unable to explain 
how the blood of a healthy person could be rendered so 
impure in a few days after going into a sickly atmosphere, 
as to cause such grave results as he often witnessed. 

SPASMODIC THEORY. 

After the discovery of the circulation of the blood, and 
after physicians had acquired a better knowledge of the 
nervous system, their views as to the cause of the phenomena 
of fever became somewhat changed. Seeing that the idea 
of an ebullition or fermentation of the blood, as understood 
by their fathers, was unreasonable, but still holding on to 
the principal idea, that the cause was some offending matter 



60 on fever: 

in the blood, and still, too, retaining the notion of a vis 
medicatrix, they imagined that the excitement was brought 
about in this way : that the morbid matter, coming into the 
extreme arteries, was then detected by a kind of sentinel 
placed at their mouths, which caused them to contract and 
prevent its passage, and, consequently, refusing passage to 
the blood also ; and that the vis medicatrix, perceiving this 
difficulty, raised an excitement in the heart -and arteries, in 
order to overcome the contraction, and force the viscid 
humors on, nolens volens, to the secretory organs, where they 
could be eliminated. It is therefore evident that those em- 
bracing this theory perceived the nervous disturbance and 
the congestion of the capillaries ; but, misunderstanding the 
cause of the congestion, were led to adopt a mode of treat- 
ment that was not the best. For, seeing that the commo- 
tion raised by their blind presiding genius was only making 
matters worse, by causing a still more profound engorgement 
in the capillaries, by forcibly pressing the blood into them, 
which they did not transmit, and thus endangering the 
integrity of the system, they resorted to vigorous blood- 
letting for overcoming the excitement, which, though justi- 
fiable when nothing better can be done, yet is always an 
evil, because of the subsequent debility which must neces- 
sarily ensue ; and still having the fear of lentor or peccant 
matter before their eyes, and having discarded the gross 
idea of a fermentation, they could think of no plausible 
way of getting clear of it, but by giving powerful secretory 
remedies to excite the organs to throw it off: hence arose 
the famous system of active purgation. Now, to excite the 
secretory organs to resume their natural action is proper 
enough, but this over-action was as blind an effort as what 
they attributed to the vis medicatrix — it prostrated the patient 
by a foolish onslaught on an imaginary enemy. That this 
system was generally successful, does not prove that it was 
beneficial; for after the doctor had bled and purged his 
patients, until he saw that he dare bleed and purge no more, 
he usually referred the case to the efforts of nature ; which, 
being let alone, often gradually brought about a restoration ; 
and though the patient did not die, yet the system was so 



SYMPATHETIC THEORY. 61 

debilitated that his health was usually ever afterwards pre- 
carious. 

SYMPATHETIC THEORY. 

In the process of time, as the nervous system was still 
better understood, and its influence in the economy more 
clearly perceived, the attention of theorists was directed 
more particularly to it, and still another theory of fever 
was gradually concocted. It was supposed that a strong 
impression being made upon the sentient extremities of the 
nerves, would be transmitted throughout the whole system 
by sympathy — not exactly through the medium of the 
nerves, but in some other way, never defined, and by some 
other power, never understood; but either the same or 
something else, in the place of the ancient vis medicatrix 
natura. But however it was defined, or however it was 
undefinable, this class of medical theorists supposed that an 
impression, once made, would be continued for a definite or 
indefinite period : as the vibrations of a musical chord con- 
tinue after it has been struck ; or like waves, which widen 
and follow each other after having been set in motion by 
the contact of a pebble with the surface of a placid lake ; or 
as vital action, once excited in an ovum, will go on until it 
converts the whole mass into an organized body, bearing 
the impress of the first cause that sprung it into motion, 
though that cause was applied but once. In some such 
way, they supposed the impression which was made by the 
remote cause upon a sentient surface was continued by in- 
dependent action until it spent its force, like the vibrations 
of a wire, or was stopped by the power of some other 
greater or contrary impression, which would set up a new 
form of action. Upon this theory was founded a new plan 
of treatment : discarding entirely the notion of peccant 
matter in the blood, the leading idea was, to give some 
medicine that would set up a different action ; which would 
swallow up or counteract that produced by the remote 
cause, and one which they fancied would be less injurious 
to the system, and would subside of itself. This was an 
ingenious and beautiful theory, but, like many other beauti- 



62 on fever: 

ful things, it led its votaries astray. It was this theory 
which introduced those potent remedies into general use, 
arsenic, mercury, and some others; and whether the morbid 
action by them set up has sent more persons prematurely 
into the other world than the diseases they were intended 
to counteract would have done, is a problem which eternity 
alone can solve. 

So completely did this theory take possession of the 
medical mind, that, within my own recollection, no physi- 
cian thought himself at liberty to neglect to mercurialize 
his patient,' in almost every form of fever of the continued 
and remittent types ; while arsenic was the remedy chiefly 
relied on for intermittents ; since then, quinine has taken 
its place, which, though not much more certain in its ope- 
ration in arresting that disease, is greatly less objectionable 
in its effects. But though both are successful, yet the 
success of neither is owing to the truth of the above theory. 

PHLEGMASIAN THEORY. 

The next theory which obtained any general notoriety, 
was what might be properly designated the Phlegmasian 
Theory, originated by the celebrated Broussais. He believed 
that all fevers originate from, or rather are identical with, 
inflammation of the stomach and bowels, and hence ignored 
the term fever, and substituted that of g astro-enteritis. 

He argued that the condition of the system known as 
fever, whether the cause be a local injury, or miasm, or 
contagion, or any thing else making a morbid impression, 
can never become developed till inflammatory action is set 
up in the stomach and bowels. 

Broussais, being learned and talented, presented his doc- 
trines in such plausible form, and defended them with so 
much ingenuity, and enforced them with such self-reliant 
confidence, that, supported by his great popularity, they 
swept over the civilized world with the force of an epidemic, 
so that, with few exceptions, all who did not fully embrace 
them were more or less impressed. What aided powerfully 
in giving currency to this theory was, that it presented 
something as a foundation which was readily recognized by 



PHLEGMASIAN THEORY. 63 

the senses — something that could be understood; and as 
the medical mind had become weary of abstractions, it 
embraced this with a zest. 

Now I think I have shown that fever consists in nervous 
disturbance and capillary inaction; and, as the capillaries 
of the chylopoetic viscera are equally involved with those 
of the surface and other parts of the system, and as they 
are all dependent upon the ganglionic system, or nerves of 
organic life, for nervous influence, and as these have their 
great centres in close proximity with the digestive organs, 
from which they receive the nervous power by which their 
functions are performed, it is not at all surprising that a 
lesion in their centres, sufficiently grave to cause general 
capillary inaction, should also develop marked evidence of 
chylopoetic derangement; and, as capillary debility and 
consequent engorgement constitute the first stage of inflam- 
mation, it is but a natural consequence that the symptoms 
characteristic of incipient inflammation in the stomach and 
intestinal canal should be evident in the early stage of most 
fevers, or that actual inflammation should afterward be set 
up by the disturbing forces. But a belief that there is 
g astro-enteritis in all cases of fever, depends upon evidence 
so far-fetched, and so little supported by fact and observa- 
tion, that it seems now passing strange that as good a 
thinker as Broussais evidently was, could have been led to 
adopt it as a foundation for a hazardous plan of treatment ; 
and still stranger that others, not biased by the pride of 
opinion or the ambition of originality, should have been also 
misled. But argument is unnecessary, as at present but a 
few fossil examples of the genus medicus retain the impress 
of this theory. But, though founded in error, this theory 
also sprang from the observance of real phenomena con- 
nected with fever, and its attempted defence was the occa- 
sion of throwing much light upon the nature of the lesions 
which take place in the digestive viscera during an attack of 
fever; as, also, to show up the sympathies which obtain 
between these organs and other parts of the economy. It 
did more ; for though in practice it caused many a poor 
fellow to succumb under the use of the lancet, yet it effectu- 
5 



64 on fever: 

ally checked the more murderous practice of hyper catharsis, 
[over-purging.] 

cooke's theory. 

Some thirty years ago, a great man, then a resident of 
Virginia, had his attention particularly drawn to the nervous 
disturbance and subsequent congestion which are such pro- 
minent characteristics of every form of fever, and, not being 
able to account for them upon the sympathetic theory, 
directed his strong investigating powers to the subject, and 
framed a very plausible theory, and instituted a mode of 
practice in accordance with it, which had a wide popularity 
for a number of years, especially in the Mississippi Valley, 
and is still adhered to by many. I refer to John Easton 
Cooke, of Transylvania. His theory was substantially this : 
First, disturbance of the nervous system. Second, weakened 
action of the heart. Third, congestion of the veins, and 
especially of the vena cava ascendens. Fourth, reaction of 
the heart, to relieve itself of the pressure of blood. Now 
this theory came very near being true : the only departure 
was this, that he made the debility and congestion of the 
capillaries secondary to engorgement of the great veins ; 
which one departure misled him, and caused him to adopt a 
mode of practice which was not the most appropriate. For, 
looking as he did upon congestion of the vena cava as the 
cause of all the other symptoms, he only thought of the 
shortest method of unloading it ; and knowing that the liver 
is the only organ which forms a secretion from venous 
blood, and therefore draws its resources directly from the 
stagnant fountain of all his fears, he, of course, chose that as 
the outlet through which the black blood, by being converted 
into black bile, could be discharged from the system. 

Cooke's theory led him to denounce the then fashionable 
practice of mercurializing ftver patients, as useless; but as 
he knew of no means which would excite the liver to 
throw off black bile equal to calomel, he chose that as his 
chief reliance ; not giving it, however, in small, salivating 
doses, but in twenty, forty, and one hundred grain potions; 
just as much, in fact, as might be found necessary to bring 



THOMPSONIAN THEORY. ' 65 

the black bile, submitting to an occasional bad salivation as 
a necessary evil. 

To calomel he added rhubarb and aloes, which formed 
his famous cava pills, and with these, and occasionally some 
other more active purgatives to make them operate, he pro- 
posed to do all that could be done in the management of 
all the forms of fever. This theory was plausible and 
easily comprehended, and the practice based on it easily 
followed : the black blood caused the disease, and this 
must be converted into black bile, and calomel must be 
given in just such quantities as would bring the black bile; 
and if the patient sunk under the ordeal, or died of a gan- 
grenous mouth, why, it could not be helped. 

Now if this great man's mind had laid hold of the fact 
that torpor of the capillaries causes the congestion of the 
large vessels, he would have directed his efforts rather to 
opening these sluices, so that the obstructed blood might 
flow on naturally again, rather than have attempted to 
empty the congested veins by the indirect process of pump- 
ing at the liver. 

THOMPSONIAN THEORY. 

About the same time as the above, another theory was 
gotten up, and a practice founded thereon, which had a 
wide-spread popularity for a time ; and though the author 
was not of the profession, and very few within its pale 
embraced it, yet as it made a great sensation, and especially 
as there were some things embraced in it which pointed to 
the truth, I shall here briefly notice it. I mean the theory 
and practice advocated by Samuel Thompson, of "number 
six" and steam notoriety ; who, though not a really great 
man, had some of the elements of greatness about him, 
viz.: inquisitiveness, some originality, great boldness, and 
indomitable perseverance. He, seeing the evidence of 
capillary debility and consequent want of vital action, and 
perceiving that in all fevers there are alternate paroxysms 
of heat and cold, and sometimes both, in excess at the 
same time, in different parts of the body, conceived the 
idea that fever consisted, essentially, in this contest between 



66 on fever: 

heat and cold ; and thus, by mistaking an effect for a cause, 
and considering heat and cold both positive entities, and 
investing them with a kind of fanciful personation, he im- 
agined that a strife for mastery was always going on in the 
system between them ; and that when heat preponderated, 
the man was well; when cold obtained the ascendency, the 
man was sick; and if cold triumphed, then the patient 
died. 

Now all that the physician had to do, according to this 
theory, was to assist the friendly power to overcome the 
unfriendly — to generate heat and subdue cold. For the 
purpose of generating heat and throwing it out, he gave 
many powerful stimulants, the best among which, and the 
one most relied on, was cayenne pepper, variously prepared. 

If he had stopped here, he would have done less harm ; 
but, filled with the idea that internal cold was the enemy 
he had to contend with, he went to work with heated rocks, 
and the vapor of vinegar and water, to drive it from its 
hiding-place. And here, for the want of a philosophic 
knowledge of the operation of the hot vapor bath upon the 
system, he worked contrary to the object intended ; for hot 
vapor, though highly stimulating to the surface, when first 
applied, soon becomes one of the most debilitating measures, 
in consequence of the exhaustion it occasions of the vital 
energies of the surface, and the profuse exhalation of the 
serum and salts of the blood. But Thompson, from what 
motive is not apparent, adopted a means which repaired, in 
a measure, the mischief he had occasioned by excessive 
steaming : at the conclusion of the operation, he threw upon 
the patient a pailful of cold water, which, being a powerful 
stimulant and generator of vital energy, tonicity, and irrita- 
bility, prevented the previous exhausting process from 
having as disastrous an effect as it otherwise would have 
had. But many a poor fellow had his vital powers so com- 
pletely exhausted by, first, the lobelia, and then the pro- 
tracted application of steam, that even the cold douche could 
not arouse him, and he died very quickly under the eye of 
his steamer. 

The most intelligent of the Thompsonians soon discovered 



THOMPSONIAN THEORY. 67 

that the steaming would not do, and abandoned it. My 
chief object in noticing this subject is to draw attention to 
the fact, that notwithstanding the steamers were not directed 
by the least glimmering of sound philosophy, yet the pow- 
erful stimulants they used, often proved so beneficial, in 
spite of the injudicious steaming, that their success at times 
was most striking — sometimes breaking up a disease in a 
single day, which, under the regular depleting regimen, 
would have required weeks. Such instances could not fail 
to draw attention ; and had it not been for an occasional 
case which suddenly went off under the operation of lobelia 
and steam, which affrighted the common observer, and the 
ridiculous absurdities which abounded in Thompson's book, 
which disgusted the intelligent, this system would have 
spread wider and lasted longer. It had its day and is 
gone, but it may be said of it, which cannot be said of some 
other theories, that the world is the better for its having 
existed. It did this, at least : it raised in the public mind 
such a horror of the abuse of mercury, that the faculty was 
obliged to curtail the use of it, in deference to public senti- 
ment. It did more than this : it satisfied many observing 
physicians that fevers could be carried to a successful 
termination by other means beside the everlasting purging 
of the liver, and that, because a man had a hot skin, he 
was not obliged to exchange it for an artificial cholera 
morbus. They saw, too, that, contrary to preconceived 
opinion, cayenne pepper did not always increase a fever, 
but that, under its influence, the heat often subsided and 
left the patient relieved without any evacuation whatever ; 
and little as the faculty may be disposed to acknowledge it, 
and, in fact, little as they may be generally conscious of the 
fact, yet, to those who have been observers for the last 
twenty years, it is evident that the Thompsonian theory 
impressed some of its features upon the regular practice, 
which was thereby improved. It cannot have escaped the 
observation of every physician w T ho has been in the prac- 
tice during the above period, that the method of managing 
fevers has, in that time, changed very materially. I speak 
generally, for there are some set-fasts in the profession, 



68 ON FEVER : 

who, as a worthy contemporary has said, " serve to desig- 
nate the exact state of theory and practice of the period of 
time when they studied their profession, or of the par- 
ticular school of which they took lessons." Such practi- 
tioners still salivate, give the cava pills, or bleed and 
nauseate, just as their preceptors did when they studied. 
But to the honor of the profession it may he truly said, 
that physicians are generally men of intelligence and dis- 
cernment, and are ever ready to embrace truth in science, 
and avail themselves of every better way of combating 
disease. 

PRESENT THEORY. 

The present seems to be a transition epoch, with regard 
to both theory and practice: the revelations of science 
have exploded all the old theories, and no well-digested 
new ones have yet been established, so as to gain any thing 
like the general consent of the profession. Old modes of 
practice have also given place to means which the enlight- 
ened observation of practitioners has discovered to be better 
adapted to subdue or counteract diseased action. We 
accordingly find bleeding only resorted to in urgent cases ; 
salivation is almost wholly discarded, as a mean's of curing 
fevers ; calomel is given less often, and more sparingly ; 
drastic purgatives mostly abandoned, and nauseants limited 
to particular cases. In the meantime, other means have 
become fashionable — almost all of which, I wish it to be 
noted, are stimulants — such as opium, quinine, spirits of 
turpentine, etc. This change has been brought about so 
gradually and so silently, that one can hardly tell when or 
how it was done, or point to any person in particular who 
has been prominently instrumental in bringing it about ; and 
many successful practitioners perhaps would be puzzled to 
give a sensible reason for the change, unless it should be 
the ever-ready one, that diseases have changed, and the 
mode of treatment had to be varied accordingly. But this 
reason is more specious than sound ; for although it must 
be acknowledged that fevers are of a lower grade of action 
in this country now than they were twenty years ago, still 



PKESENT THEORY. 69 

the difference is not so great as to sanction a contrary mode 
of treatment. The description of fevers by our oldest 
authors will do very well by which to identify them yet. 
Even the modern disease, as some suppose it, typhoid fever, 
was very accurately described by Sydenham in 1685, under 
the name of stationary fever. The fact is, man has remained, 
ever since we have any history of his characteristics, very 
much the same kind of animal : he eats and sleeps, loves 
women and wine, and other excitements, just as he did in 
the days of father Noah. The laws of nature, I suppose, 
have since that time undergone but little change, and it is 
fair to presume that, both remaining the same as of old, 
like causes will produce like effects still. But while the 
laws of matter and of vitality have remained the same, 
man's knowledge of them has been steadily enlarging, and, 
as a consequence, there has been a corresponding change in 
the means which he calls into requisition to correct the 
aberrations of vital action as he has improved in the know- 
ledge of the workings of the vital forces and the nature of 
their aberrations, and the nature of curative agents with 
regard to the relation they sustain to the vital forces. And 
I am proud to be able to say, in truth, for the profession of 
the present age, that they have made larger advances in 
obtaining a correct knowledge of the laws of matter and of 
life, than were accomplished in any other, or, indeed, in 
many other centuries ; and I am glad that I can say that 
the practice of the present time is not what it was when I 
studied the rudiments of my profession : the change has 
been for the benefit of mankind, as well as for the honor of 
the profession of medicine. 

But to return to the subject under consideration, that the 
present prevailing practice is a stimulating one, and there- 
fore this plan of mine is in harmony with the tendency of 
the age. I claim very little that is original ; merely this, 
that I have pointed out, somewhat more clearly than was 
before done, the nature of the remote cause of fever, the 
kind of impression first made upon the system, and the 
effects produced by these impressions ; and then pointed out 
the means by which these effects can be best removed. I 



70 on fever: 

have shown why stimulation should cure, and how it cures, 
and thus, by understanding exactly what is wanted to be 
done, I have been the better able to select the exact articles 
best adapted to meet the indications. I have said that 
opium, quinine, and spirits of turpentine are the means now 
most relied on in the treatment of fevers, and we know that 
they are all powerful stimulants ; and I contend that it is 
exactly because they are stimulants that they have attained 
their present popularity. But they are not the best stimu- 
lants for this particular purpose. Opium is essentially a 
nervous stimulant ; given in moderate doses, it excites the 
nervous centres and causes increased nervous power to be 
sent out through the whole system, and in this way becomes, 
indirectly, a general stimulant. But in large doses it over- 
whelms the brain and other nervous centres, and disqualifies 
them for sending out their usual influences ; hence loss of 
consciousness, loss of sensation, diminished circulation, 
diminished or suspended secretion, diminished irritability — 
in short, diminished vitality. And although there are occa- 
sions when the bringing about of this fearful state of things 
is not only proper, but imperatively called for, yet it is 
always obtained at a serious loss of vital energy, and should 
not be resorted to when less objectionable means will suc- 
ceed. 

The same objection lies against the use of quinine. It 
too is a nervous stimulant, and unquestionably produces its 
specific effects by stimulating the nervous centres : all who 
have taken it in moderate doses will testify to the pleasura- 
ble excitement it occasions, and all who have taken it in 
large doses can equally testify to its horrid effects upon the 
brain; no other kind of intoxication is so insufferable. 
And although I would regret the loss of this Samson 
stimulant, still I would never use it for exciting the capil- 
laries, by its indirect action through the medium of the 
nerves, when I could obtain a better result by the direct 
action of piperin, without any expense to the nervous sys- 
tem. It is true, I give in my prescription a nervous stimu- 
lant, the valerian, but it is one of a mild nature, not capable 
of producing intoxication like opium and quinine, and there- 



PRESENT THEORY. 71 

fore not liable to exhaust the vital energies. Some persons 
with whom I have conversed on this subject have seemed 
to labor under some difficulty in understanding the differ- 
ence between direct and indirect stimulation; this appears 
to me to be very plain : direct stimulation is obtained by 
exciting the part itself, indirect stimulation by exciting the 
origin of the nerves, by which a part is supplied : the kid- 
neys may be stimulated directly by giving a diuretic, and 
they may be stimulated indirectly by acting upon the brain 
by fear. The stomach may be excited to vomiting by an 
infusion of mustard, or by presenting disgusting images to 
the mind, or by a concussion of the brain ; so the capillaries 
may be excited by the direct action of piperin carried to 
them by the blood, or it may be done indirectly by exciting 
the brain and spinal marrow, and increasing the nervous 
irritability sent to them. But it may be asked, Why should 
indirect stimulation produce exhaustion rather than direct ? 
I answer, first, because every unusual excitement of a 
nervous centre has a tendency to weaken its energies ; we 
know that this is true, because every time a nervous stimu- 
lant is repeated, the dose must be increased, in order to 
obtain the same effect ; this is true of alcohol, opium, qui- 
nine, and every other nerve-stimulant. And secondly, the 
reverse is true of direct stimulation : the more the senses 
are exercised, the more acute they become — that is, they 
are more easily impressed by their appropriate stimulants ; 
the oftener emetics are administered, the less doses will be 
required to produce emesis, [vomiting;] the oftener the 
surface is excited by friction or the cold bath, the more 
active it becomes ; and so of all direct stimulants. The 
philosophy of it is, that they act not upon the nerves them- 
selves, but upon the irritability of the part which the nerve 
has supplied. We must recollect, however, that even direct 
stimulation may be so powerful as to exhaust the irritability 
of the part, when no further impression can be made until 
it is restored ; thus, the skin may be stimulated by rube- 
facients [mustard, etc.] until it becomes insensible ; the 
bowels may be over-stimulated by drastic purgatives until 
nothing will excite them ; but ; unless carried to this stage 



72 on fever: 

of exhaustion, the more any part is stimulated by direct 
action, the more impressible it becomes. I think these 
reasons are explicit enough upon the subject, and show why 
medicines which act primarily upon the brain exhaust the 
system, and should not be resorted to unnecessarily. 

But to return to the subject. Spirits of turpentine is the 
next stimulant now most relied on in the treatment of fevers, 
and is much less objectionable than opium or quinine, as it 
is a simple, direct stimulant; but there are objections that 
lie against it also. It is disagreeable to the taste and 
offensive to the stomach, and, in considerable doses, is too 
powerfully stimulant to be borne well by* the coats of the 
stomach and bowels ; and when taken into the circulation, 
it often acts so powerfully upon the kidneys as to produce 
subsequent weakness in these organs. In the oil of sassa- 
fras I find a less objectionable remedy ; it is pleasant to the 
taste, grateful to the stomach, harmless to the mucous sur- 
face of the alimentary canal, it readily enters the circula- 
tion, and acts as a valuable assistant to the piperin in stimu- 
lating the capillaries. Besides these important effects, as 
has been said before, it reaches the nervous centres and 
destroys or neutralizes the remote cause,- thereby preventing 
any further injurious effect upon the system. 

MODES OF CURE. 

Some, perhaps, may think lightly of my system, because 
it promises to do so much by means of so few remedies ; 
but it is not more restricted in its means than many other 
systems which have at different periods obtained the ascen- 
dency and run the round of popularity. In fact, every 
theory of fever has suggested a certain class of remedies 
as the appropriate means for effecting the object thought 
necessary to be accomplished, and these means have gene- 
rally been few. 

The Humoralists relied upon a few bold detergents ; the 
disciples of Cullen and of Rush, upon the lancet, and a few 
other debilitants ; the Sympathetics,' upon mercury almost 
entirely ; Broussais, upon the lancet and demulcents ; the 
followers of Cooke, upon calomel and the cava pills ; and 



MODES OF CURE. 73 

the present dominant practice embraces little more than the 
trio, opium, quinine, and turpentine. 

The fact is, that this limiting of remedies is characteris- 
tic of science, and distinguishes it from empiricism. 

In the dawn of medical knowledge, when there was 
nothing to guide the practitioner but blind experience, a 
doctor's prescription often embraced a multitude of medi- 
cines—sometimes as many as fifty, including those of the 
most diverse and contrary powers; and while some of these 
might happen to suit the case, others would be useless, and 
others injurious. It is the glory of the scientific physician 
of the present day, that he gives nothing without having 
a specific object in view, which he expects to accomplish 
by its exhibition; and as the elements of disease are 
always few, it follows that the better these elements are 
known and recognized, the fewer will be the means called 
into requisition to meet the indication. 

It would be very strange if any theory should be origi- 
nated by a great mind, and receive the assent of the learned 
for a considerable time, unless it were founded upon some 
ascertained undeniable truths. We accordingly find that 
each of the theories of fever which have received the con- 
fidence of the medical profession at different periods, was 
based upon some of the recognized phenomena presented 
in the progress of the disease, and hence all contain some 
truth. The ancient Humoralists perceived the nervous dis- 
turbance and the capillary engorgement, and if the case 
terminated favorably, they saw that much morbid matter 
was thrown off by the secretory organs, and believed that 
these vicious humors had caused the disease. Now it is a 
truth that morbid matter does accumulate in the blood in 
every case of fever, but it is a consequence, and not a 
cause : the secretions being suspended by the debility of 
the capillaries, and the spasm or altered sensibility of their 
secretory terminations, a retention of the excrementitious 
parts of the blood is the consequence, and a depravity of 
that fluid is the result. But the condition of things which 
caused the fever and suspended the secretions must first be 
removed, either by art or nature, before the secretory 



74 on fever: 

organs can be made to act, so as to depurate [purify] the 
blood ; so that the cure is actually performed before the 
expulsion of the morbid matter. 

The next theory in succession — that of spasm of the 
extreme vessels, and peccant matter in the blood — was 
based upon the observance of pretty much the same phe- 
nomena as the pure humoral. Those who embraced this 
theory had their attention drawn to the spasm which evi- 
dently takes place in most cases of fever in some degree, 
and in high grades forms the most prominent symptom; 
and supposing that the engorgement of the capillaries was, 
in all cases, wholly caused by this spasm of their mouths, 
went to work to cure the disease with this idea prominent 
above all others. But this spasm is not the prime cause 
of the congestion of the capillaries, for the congestion takes 
place in the stage of depression, before there is any evi- 
dence of spasm, which only comes on during arterial excite- 
ment, and gives way when that is allayed. In low grades 
of fever, there is little or no evidence of spasm at any 
time ; and in the collapsed stage of all grades, it is not 
only wholly absent, but the mouths of the capillaries are 
often so relaxed, that they pour out, as we have seen, the 
fluid constituents of the blood without check and without 
alteration ; producing effusions, colliquative sweats, or 
diarrhoea. But the purple hue of the surface shows that 
the capillary debility and engorgement are still not at all 
relieved. 

The sympathetic theory was based less upon truth and 
reason than either of those which went before it; still, 
there may be found some support for it in analogy : we 
know that a specific action does obtain in some forms of 
chronic disease, by which a peculiar organization is pro- 
duced, and until the specific action of the vessels is 
changed, they will manufacture no other product ; but the 
action in fevers is not specific, but is simply too high or too 
low. and all that is necessary to be accomplished, in order 
to remove the disease, is to equalize the action; for as soon 
as this is done the fever is gone, though the patient may 
still be feeble and require time to regain his vigor ; yet the 



MODES OF CURE. 75 

moment there is harmony established between the action in 
the large blood-vessels and the capillaries, the fever is de- 
stroyed. 

The Broussain theory being based upon supposed inflam- 
mation in the stomach and bowels — a circumstance which 
often does actually exist in many cases of fever, and in all 
there is that condition which constitutes the first stage of 
all inflammation, viz., nervous disturbance and capillary 
debility, followed by engorgement — had therefore many 
undeniable facts to lean upon ; but as this condition of the 
digestive organs is only a part of a general condition ob- 
taining throughout the entire system, it must therefore be 
a consequence and not the cause of the febrile movement ; 
in other words, the aberrations observed in these organs 
being coexistent with like aberrations in every other part, 
must be referable to the same cause ; and, in fact, all do 
arise from general nervous disturbance, which has produced 
general capillary debility. The one idea of the disciples 
of this theory was to subdue inflammation, which naturally 
suggested the lancet, demulcents, tisans, etc. 

The next theory considered was that of venous conges- 
tion : this had a most prominent phenomenon, one that is 
conspicuously observable in every case of fever, to rest on. 
But it is strange that the far-seeing mind of Professor 
Cooke failed to perceive that venous congestion cannot, in 
the nature of things, ever take place without capillary 
obstruction : mere weakened action of the heart can never 
be the cause of venous congestion ; for while the capillaries 
continue to act with usual vigor, there can be no oppres- 
sion of the heart, for we see that they pass the blood on 
from the arteries to the veins, even after the heart alto- 
gether ceases its motion ; and if the heart acts, though it 
should be feebly, it will send the blood on and relieve the 
veins, unless there is obstruction. We often see those 
whose pulse is ordinarily so feeble that it can but barely 
be felt, and yet the individual feels well — there is no ven- 
ous congestion; and, on the contrary, we often find the 
heart in the hot stage of fever beating with many times its 
usual force, even causing the whole frame to tremble under 



76 on fever: 

the shock of its power; yet there is, nevertheless, great 
venous congestion at the same time. So we see that Cooke 
was wrong in giving weakened action of the heart as the 
cause of venous congestion. Capillary inaction is the 
cause, and the congestion can be removed in no other way 
than by restoring the action of the capillaries. 



MYSTERIES CONNECTED WITH FEVER. 77 



CHAPTER Y. 

MYSTERIES CONNECTED WITH FEVER. 

Fordyce, in his Treatise on Fever, mentions a number of 
phenomena connected with its history which he considered 
mysterious, and professed himself wholly unable to explain. 
Subsequent writers have also failed to give any solution of 
these difficulties. Now, as I profess to have discovered 
the true condition of the system in which the febrile move- 
ment consists, and the nature of the remote cause which 
produces this condition, it might be expected that I should 
be able to point out, more clearly than had been done, the 
cause of the phenomena which grow out of the febrile move- 
ment ; and I think I am not mistaken in the opinion that I 
can, in a good degree, succeed in meeting this expectation. 
I will, therefore, take up the difficulties as they are pre- 
sented by Fordyce, and endeavor to show that they all are 
natural results, growing out of the nature of the remote 
cause of fever, and the condition of the system brought 
about by its ordinary operation. Now if these explanations 
were only interesting to the curious inquirers after abstract 
scientific truth, they would be omitted in this work ; but, 
as they will not only serve to throw much light upon the 
nature, causes, phenomena, and effects of fever, afford 
much practical knowledge as to the effects of various reme- 
dies in its treatment, and suggestions as to how the disease 
may be prevented, and especially as they throw much light 
upon the leading doctrines upon which the successful treat- 
ment recommended in this work is founded, I am satisfied 
the reader will find ample compensation for devoting the 
time and attention necessary for a very careful perusal. 



78 ON FEVEK: 

The first mystery which Fordyce points out is, that the 
remote cause is more operative in the night than in the 
day; the second is, that paroxysms of intermittent fever 
occur principally in the day ; and the third is, that in con- 
tinued fevers there is commonly an evening exacerbation. 
I will include the explanations of all these in one chapter, 
as they grow out of the same circumstances. 

The points upon which these explanations are based have 
been pretty fully dwelt on in the preceding pages of this 
work, and will here only be stated, viz. : that the remote 
cause of fever is of the nature of a narcotic poison, a 
nervous depressor; and the condition of the system pro- 
duced by its operation is that of narcotism or nervous 
depression, followed by nervous disturbance and capillary 
debility ; and that the hot stage or reaction in fever grows 
out of these, with all the other phenomena, as pains, aches, 
suspended secretions, etc., etc. 

It is a well-established fact, that exposure to the cause 
of fever in the night, is much more apt to bring on an attack 
than the same exposure during the day. Certain malarious 
districts, which can be visited in the day with compa- 
rative impunity, cannot be remained in during the night 
without the most imminent hazard of an attack of fever, 
and more especially if they be slept in. The same thing 
has been observed to be true, in a less degree, in every 
malarious district which has been made the subject of 
observation. But why this is so, has never been clearly 
accounted for. 

There probably are several cooperating causes ; but the 
one most operative is, as I think I can show, that at night 
there is a lower degree of vital energy possessed by the 
system than in the day. That there is less vital energy at 
night, is evident from many considerations : the system is 
much less impressible — which is a beneficent arrangement 
of our Creator, by which we are better able to compose the 
body to sleep. The same amount of noise or other annoy- 
ances will not keep a person awake' in the night that will 
have that effect in the day ; and this is not because of the 
habit of taking sleep at night ; for I have conversed with 



MYSTERIES CONNECTED WITH FEVER. 79 

a number of men whose business required them to be awake 
all night, and forced them to take their sleep in the day, 
who all informed me that slighter causes prevented sleep 
than did when they slept at night. It is not because of 
the stimulus of light, for persons soon acquire a habit of 
sleeping in a strong light, and often prefer it. It can, 
therefore, only be accounted for by admitting that the 
nerves are less impressible in the night than in the day. 
Many other sources of evidence that this is so could be 
given if it were necessary ; for example, we do not digest 
as well in the night; are more subject to take cold from 
exposure, etc.: all showing a weak condition of nervous 
energy. 

Carpenter admits the fact that nervous sensibility is less 
in the night than in the day, and, among other evidences of 
this, refers to the well-known circumstance, that a much 
greater effect will be produced by drinking a given quantity 
of alcoholic liquor in the morning than in the evening. He 
does not attempt to account for this, but I presume it arises 
from the same cause which operates upon certain plants and 
flowers to induce them to fold up their leaves or petals in 
the evening, as though about to die, but which expand 
again in full vigor to greet the morning sun. Solar light, 
or something in connection with it, plays an important part 
in the business of vitalization. But not to go into any 
speculation as to the cause of the deficiency of vital power 
experienced in the night, I will assume it as a fact conceded 
by the best writers, and abundantly susceptible of proof. 
Even Wagoners are fully aware of this fact, and hence will 
allow their teams to rest, especially in the latter part of 
the night, should they have to drive the harder in the day. 

The traveller who rises before day to press forward on 
his journey, will find both himself and steed injured by the 
imprudence, and both will fail, if the journey be long, sooner 
than he who takes his morning rest, and pushes harder in 
the day, even beneath a tropical sun. But whatever the 
cause may be, it is certain that it is less operative in the 
first than in the latter part of the night. Fordyce supposes 
that the greatest liability to be impressed by the cause of 
6 



80 ON FEVER : 

fever is between the hours of eight in the evening and eight 
in the morning, and that the liability is much greater in the 
latter half of this period than in the first, viz., between two 
and eight in the morning. Southern planters have arrived 
at the same conclusion by observation alone, and hence find 
it better to let their hands remain in-doors in the early 
morning, and work them later in the evening. 

It would therefore seem, that either the supply of vital 
influence, which is generated during the sunny hours, lasts 
for some time after, they have fled, or that the solar rays 
leave the air charged with vivifying power, which is ope- 
rative for a time after they are shut off; and that it is only 
after the sun has again blessed the earth for a season, that 
this vital influence is felt in sufficient force to restore the 
nervous power to its full vigor. Hence the almost universal 
desire for stimulation in the morning, laying the foundation 
of the old custom of the morning dram, (better broken than 
kept, however,) and the still more universal one of the 
morning cup of tea or coffee. Hence, too, the well-known 
fact that the convalescent and the valetudinarian dare not 
venture abroad during the early morning hours. It is there- 
fore certain that nervous sensibility and nervous powder are 
both less in the night than in the day. But the inquiry 
may naturally arise, If the nerves are less impressible in 
the night, and the cause of fevers acts upon the nerves 
primarily, how comes it that a greater effect is produced ? 
This question implies the idea that the cause of fever ope- 
rates by producing nervous sensation. Now sensibility re- 
sides in the remote nervous expansions, and only there ; 
and sensation can be excited in no other way than by 
impressions made upon these expansions. But almost 
all writers upon the subject now agree that the poison 
which causes fevers does not act by impressing the sen- 
tient nerves on the surface, or in the lungs, or alimentary 
canal, but that it enters the circulation, and reaches the 
brain and other nervous centres, and there exerts some 
influence upon the nerve-matter, which sets up in it a morbid 
condition, and that morbid innervation is only a manifestation, 
an evidence, a symptom of this condition. 



MYSTERIES CONNECTED WITH FEVER. 81 

Now a living organization possesses the power to a cer- 
tain extent of preserving itself from, or resisting the action 
of, hurtful agents ; and this power of resistance is known 
to be in direct proportion to the degree of vital action that 
may be possessed at the time — and vital action, we know, 
is dependent on, or rather is the direct result of, nervous 
power. The brain and nerve-matter in general is as much 
dependent upon the vital action of the capillaries which 
enter into its structure for a due performance of its function 
as is the liver, or any other organ, and hence we can perceive 
a good reason why the nerve-matter should be more easily 
injuriously impressed when nervous power is deficient than 
when it is in full vigor. But perhaps some one may say, 
As you believe the cause of fever to be something having 
the properties of a narcotic stimulant, of a nature somewhat 
allied io opium, alcohol, etc., and as you have admitted that 
persons are less excited by these at night than in the morn- 
ing, how is it that the reverse is true with regard to the 
fever poison ? This question arises from confounding nerv- 
ous impression with nervous lesion. Now, though alcoholic 
stimulants do produce more excitement in the morning than 
they do at night, yet by being drunk at night they prove 
much more injurious than when drunk in the day : common 
observation has decided that he that drinks in the night will 
not live long, while the belief is equally general that a 
morning dram is good for health. Now, however erroneous 
the latter conclusion may be, it is certain that between 
drinking in the night and drinking in the day, the odds in 
the injury done the system are all on the side of the former. 
It amounts then to this, that narcotic stimulants do not 
injure the system by the amount of excitement they pro- 
duce, but by the injury done to the nerve-matter itself, and 
these effects are not at all the same, are not even coincident 
in either time or place. 

Excitement is the immediate effect of the direct impression 
of the stimulant on the sentient extremities of the nerves 
of the stomach. This is felt in full force within a few 
minutes after imbibing the potation ; an hour or so later, 
enough of the stimulant has been absorbed and entered the 



82 on fever: 

circulation to begin to manifest its deleterious effects upon 
the nervous centres : we now have a mixed effect of stimu- 
lation and intoxication. But if the draught has been large, 
in the course of a few hours more the direct effect made by 
the absorbed poison upon. the nerve-matter so far prepon- 
derates over the impression made upon the nervous extre- 
mities, (though the stomach may be again plied with fresh 
potations,) that excitement becomes as nothing, and intoxi- 
cation profound. 

I hope I am now understood, that stimulation is in the 
stomach, and is conveyed by nervous connection to the 
brain, and sent out to the whole system by reflex nervous 
action ; but that narcotism or intoxication takes place in the 
brain itself, and other nervous centres, by the direct action 
of the absorbed poison, through the medium of the blood, 
and that the torpor of drunkenness is not a sensation sent 
out from the brain and spinal cord, but a want of nervous 
power occasioned by a lesion of the brain matter, by which 
it is disqualified for performing its functions of elaborating 
nervous fluid. 

It therefore can be readly understood how this low state, 
of nervous power, which has been shown to exist at night, 
should render the system more susceptible to the deleteri- 
ous influence of narcotic poisons, whether alcohol, opium, 
or malaria, and that we should expect the cause of fever to 
more readily impress the system at night than in the day. 

The next inquiry is, Why do the paroxysms of intermit- 
tents occur principally in the day ? Fordyce says, that so 
great is this tendency, that a retarding intermittent, after 
having travelled through the hours of the day, in place of 
keeping on through the dark hours, will leap over the night 
and occur the next morning ; and an anticipating intermit- 
tent, in like manner, will travel backward through the hours 
of the day, and, skipping over the night, will come on the 
previous evening ; so that in an anticipating quotidian there 
may two paroxysms occur in the same day. Now, pre- 
paratory to an attempt to explain ■ this phenomenon, and 
give a reason for it, it will be well to consider what is the 
cause of a paroxysm of intermittent fever. I am aware 



MYSTERIES CONNECTED WITH FEVER. 83 

that chills and rigors are supposed to be the result of depres- 
sion, and so they are remotely, but not immediately. A 
regularly built chill or shake of an intermittent is really the 
result of reaction — it is the first unsteady rebounding of the 
nervous power, and the more vigorous the rebound is, the 
more violent will be the rigors. Fordyce gives the full 
weight of his great character as a close observer in support 
of this position, though he merely stated a fact without per- 
ceiving its tendency. He says that whenever there are 
rigors, the patient will not die in that paroxysm — showing 
that rigors are evidence that reaction has commenced. 
Everybody in the South and West knows that if a fever is 
turned to the shakes, the danger is over. Is it not fair, 
then, to infer, as the fully developed rigor is the result of 
reaction, that the less degree of the same state, known as 
chill, is occasioned by the same thing, less operative ? But 
I acknowledge that there are conditions, called chills, which 
are not the result of reaction, as in low grades of pernicious 
fever ; but in them there is no sensation of a chill ; on the 
contrary, the patient has a sensation of heat. I cannot now 
stop to explain this condition, but it is very different from 
the first stage of a paroxysm of ordinary intermittent fever. 
But though I contend that rigors are the result of reaction, 
it is not arterial reaction, but is simply a rebound of the 
oppressed nervous power, and when the nervous reaction 
becomes tolerably perfect, it brings about arterial reaction. 
We are now prepared to comprehend why the increased 
nervous power and nervous sensibility, in the day, should 
invite nervous reaction; and why it does not often take 
place in the night, when nervous power and sensibility are 
lowest. So that, while the low state of vitality in the 
night favors the impression of the remote cause of fever, 
the higher state of nervous power in the day excites the 
reaction which produces paroxysms of inter mittents. 

We have only now to find a solution of the last query. 
How account for evening exacerbations in continued fevers ? 
Every writer admits that fevers are usually worse in the 
evening than in the morning, but the cause has been an 
enigma, about which few have ventured even a conjecture. 



84 ON FEVERS : 

But admitting the conclusion, which has been fairly 
arrived at, that there is a lower degree of nervous power in 
the evening than in the morning, and another fact, which is 
generally conceded, viz. : that malaria enters the circulation 
— to these append the conclusion, which I think has been 
honestly drawn, that malaria is of the nature of a narcotic 
poison, we can then easily perceive that it, like all other 
narcotics, will exert an influence upon the nervous system, 
more or less readily, as nervous power at the time may be 
more or less vigorous ; and that, as the morbid sensations 
which are felt in the system are nothing more than symp- 
toms of the altered condition of the nerve-matter at the 
time, it is reasonable to suppose, nay, is absolutely certain, 
that these symptoms will be aggravated just in proportion 
as the impression upon the nerve-matter becomes more over- 
powering, and the resistance afforded by vital action less. 
We would therefore expect, that though the continued force 
of narcotic power of the remote cause remains the same in 
the morning as in the evening, yet its effect in producing 
nervous disturbance would be as much greater in the even- 
ing as the vital action is weaker. And even should the 
original cause have ceased to act, and the disease be the 
effect of the condition brought about in the nervous centres, 
yet it is certain that this condition would interfere more 
potently with the exercise of the natural function when the 
vital action was lowest than it would when more lively, 
and that greater nervous disturbance would be the conse- 
quence. But we have shown that the febrile movement is 
the joint result of nervous disturbance and capillary inaction. 
Now, though the action of the capillaries is not immediately 
dependent upon nervous influence, yet the poiver to act is 
certainly derived from the nerves, and is soon lost if nervous 
power is cut off; so that a lower degree of nervous power 
will soon produce a lower activity in the capillaries also ; 
and hence, the whole mystery of evening exacerbations in 
fever can be unravelled as follows : In the evening nervous 
power is less, and vital action weaker; and, as a conse- 
quence, the effect of the morbid condition produced by the 
remote cause of fever in the nervous centres is proportion- 



MYSTERIES CONNECTED WITH FEVER. 85 

ally greater in causing morbid innervation, giving rise to 
increase of pain, restlessness, throbbing of the heart, and 
other evidences of nervous disturbance. Further, capillary 
action is in proportion to nervous power, and this being 
weaker in the evening, capillary action will be weaker also, 
occasioning, by necessity, an exacerbation of fever, for 
fever consists in nervous disturbance and capillary inaction 
— the disturbance in the general circulation, equally with 
all the other phenomena of fever, being a consequence of 
these ; for the heart being supplied with morbid nervous 
influence, and being unduly excited by the stimulus of dis- 
tension, occasioned by the partial stoppage of the blood in 
the capillaries, causing it to accumulate in the large arteries, 
increased action is the consequence. We therefore have, 
as the elements of an exacerbation of fever, increased nerv- 
ous disturbance, decreased capillary action, and excitement 
of the heart and arteries ; manifested by an increase of the 
pain, restlessness, headache, delirium, heat of the surface, 
paucity [scantiness] of secretions, etc. 

But the reaction in the arterial system will, after a while, 
partially relieve the capillary torpor, and a better capillary 
circulation will cause an increase of nervous power ; better 
nervous influence will be sent throughout the system, and 
a general amelioration will take place in all the symptoms, 
constituting the morning remission. 

It appears, therefore, that answers to all the three 
inquiries which form the present subject can be found in 
the same facts, and that all can be contained in a nutshell, 
viz. : the cause of fever being a nervous depressor, and 
nervous power being lower at night, and vital action of 
course weaker, the nervous centres are, consequently, easier 
impressed injuriously ; and that, although nervous power 
has a tendency to react after depression, yet it cannot do 
so until it gains force, or is aroused by some stimulant; 
therefore, no reaction takes place ordinarily until the stimu- 
lus accompanying the sun's rays arouses it ; the first effect 
of which is manifested by that kind of reactionary effort of 
nervous power which produces the constriction of the sur- 
face characterizing a chill, or the irregular muscular action 



86 on fever: 

producing rigors. But sometimes this nervous reaction is 
so very slight that nothing more than a little shrinking and 
dinginess of the surface are perceptible ; and this, too, 
rather late in the day, so that the arterial reaction which 
follows is continued into the fore-part of the night, making 
the evening exacerbation in continued fever. 

HOW FEVER TERMINATES IN HEALTH. 

Speaking of the natural tendency of most fevers to termi- 
nate in health, Fordyce says, page 121 : " The author has, 
therefore, never seen, nor can himself conceive of any cause 
why a simple paroxysm of fever should go through its 
three stages, (cold, hot, and sweating,) and terminate in 
health." Now this does not appear to be so very myste- 
rious ; the whole process may be explained as follows : The 
malaria, whatever else it may be, is a nerve stimulant of a 
depressing kind ; the nerves bear the impression for a 
certain time without yielding to its influence, or, in other 
. words, becoming impressed ; just as they will stand a 
certain amount of tartar emetic, (which is known to act by 
entering the circulation and impressing the nervous centres, 
particularly at the origin of the gastric nerves,) but if the 
amount be increased, there comes a time when they can 
resist it no longer, and great nervous prostration and sick- 
ness are the consequences : just so the nerves or nervous 
centres may be annoyed by the action of malaria, and 
appear not to feel it, but finally they become impressed, 
and then the condition of nervous prostration is at once pro- 
duced which characterizes a chill or cold stage of fever. 
But, as we see in the case of tartar emetic the nervous 
depression giving place to reaction, causing violent contrac- 
tion of the gastric and other muscles, a sense of heat over 
the whole body, and increased power and velocity of the 
heart's action, so it is in the other case also — the nervous 
system reacts, and increased nervous power or influence is 
sent throughout the whole system ; the heart is called into 
increased action, the sensibility of the whole system is 
exalted, and all the phenomena of the hot stage of fever are 
witnessed. And were it not for the debility of the capil- 



HOW IT TERMINATES IN HEALTH. 87 

laries which had been brought about by the previous action 
of the malaria, either by direct or indirect influence, the 
paroxysm of excitement would be, in this case, as ephemeral 
and would do as little harm as that occasioned by the tartar 
emetic. But the capillaries offering a resistance to the 
passage of the blood, all the phenomena of capillary con- 
gestion are added to those of arterial excitement, and the 
hot stage is protracted until the excitement has aroused the 
action of the capillaries — the first evidence of which is that 
those which compose the exhalants of the surface commonly 
relieve themselves of the congestion by pouring out perspi- 
rable matter ; the other capillaries also go to work, but are 
not so immediately under our observation ; the mouth 
becomes moist, dryness leaves the throat, the urine is again 
secreted, etc., etc. Now if the nervous debility of the 
capillaries has been but slight and of a short continuance, 
the excitement of the hot stage often restores them com- 
pletely, and unless the remote cause is continued in its 
action, there will be no tendency to the production of a 
second paroxysm ; and we often see examples of this in 
fevers occasioned by mere fatigue and exposure. But, 
generally, the debility of the capillaries is only partially 
and temporarily relieved by the reaction, and when it sub- 
sides in consequence of the relief of congestion obtained by 
secretion, the debility still remaining, and the first cause of 
the nervous disturbance still in action, a second paroxysm 
is brought about, precisely as the first was ; but as the 
nervous disturbance will generally become less and less, 
either by the remote cause ceasing to act, or from the 
nervous matter becoming less and less sensitive to its influ- 
ence, the capillaries become more and more perfectly restored 
to their natural condition, and the paroxysms will cease to 
return, except from mere force of habit, and this is often 
broken up by the occurrence of some considerable mental 
excitement, produced by accident or purposely planned. 
Thus we see that it is very natural and reasonable that the 
regular stages of fever should terminate in health. 



88 ON FEVER : 



HOW FEVERS CURE OTHER DISEASES. 

Another circumstance which has been noticed by For- 
dyce and others, as often observed in association with the 
history of cases of fever, and which has been considered 
inexplicable, is that other diseases which the individual 
had been suffering under, at the onset of the attack of 
fever, are very often removed and disappear with the sub- 
sidence of the fever. Fordyce says, "Fever thus, and 
many other violent diseases, (which go on in a similar man- 
ner,) proceeding through their natural course, often leave 
the patient free, not only from the disease itself, but also 
from the decay arising from some less violent disorder, that 
had not in itself a natural tendency to terminate in health. 
Perhaps the manner in which this happens will ever re- 
main inexplicable." But when we remember that the 
elements of diseases are few, how varied their effects and 
manifestations may be, and consider, too, the nature of 
these elements, it will not appear strange at all that the 
removal of the condition which causes the phenomena of 
fever will also remove the condition in which various other 
diseases essentially consist. In analyzing diseased action, 
we find it resolves itself into a very few simple elements : 
these are, alteration of the condition of the nervous power 
or sensibility of the local part, or of the whole system ; 
diminished or morbid capillary action ; and the changes of 
structure or morbid deposits, which are the results of the 
deviation from a normal condition of the nervous influence 
and capillary action. Now many diseases, which are very 
annoying, consist entirely in debility or perverted action of 
the capillaries, and it is reasonable enough that the reaction 
of the nervous influence, which brings about the hot stage 



of fever, and the general capillary excitement which is 
occasioned by that hot stage, should not only arouse the 
capillaries in general into healthy action, but also bring up 
these, which were particularly concerned in making up the 
disease previously suffered, to the point of healthy exer- 
cise ; and thus, by removing the very condition out of which 



HOW IT CURES OTHER DISEASES. 89 

the phenomena of that disease grew, it, as a matter of 
course, could afterward have no existence. 

We will take the case of an indolent ulcer, as a good 
example for illustration. We know that there is want of 
nervous influence : its insensibility to applications which 
w r ould produce great sensation when applied to a recent 
healthy abraded surface, proves this ; there is also much 
capillary debility, as is manifest from the congested state 
of the part and its venous color ; the nervous power and 
capillary action, therefore, are too low to bring about a 
reparation of the lost parts ; and when efforts are made, 
the vitality of the product is of too low an order, and it 
proves an abortion and is sloughed off, or is removed by 
destructive absorption. Now, the general reaction in the 
nervous system, and the general excitement in the capillary 
system, characterizing a natural and well-developed case of 
fever, often extend with such efficacy to this local part as 
to bring it under the general influence, so as to permanently 
elevate it into a natural condition ; and when the process 
of reparation is fully developed, which restores the loss of 
material which is suffered in the course of every case of 
fever, this part also is included in the general reparative 
effort, and a radical cure is the result. But sometimes we 
see the very reverse of this take place : instances are 
numerous in which the general powers of the system are 
so far exhausted by the ravages of a protracted case of 
fever, and especially if its vitality has been further de- 
pressed by the improper exhibition of mercury and other 
depressing agents, that although a reaction is set up in the 
general capillary system sufficient to bring about a tardy 
convalescence, yet some of the parts most remote from the 
centre of vital influence, or which have been more seriously 
debilitated by local applications, or possess naturally a 
lower order of vital action, fail to respond to the general 
recuperative reaction ; and destructive absorption destroys 
the integrity of the part, and very obstinate ulcers are the 
consequence. In other cases, the general reaction is barely 
sufficient to prevent actual dissolution, and the whole capil- 
lary system remains permanently debilitated ; every func- 



90 on fever: 

tion is performed with difficulty and imperfectly, causing 
the patient to linger out a miserable existence, poorly com- 
pensating him for a brief respite from death. In other 
cases the capillaries of some important organ, which had 
suffered most during the progress of the fever, remain 
debilitated, and the patient suffers from a want of the per- 
formance of its particular function. It may be the stomach, 
causing indigestion; the bowels, producing costiveness or 
chronic diarrhoea ; the liver, spleen, or kidneys, occasioning 
the evils resulting from an imperfect performance of their 
office ; or, what is still more deplorable, it may be the 
capillaries of the brain itself which remain debilitated, pro- 
ducing mental imbecility or idiocy. It is, therefore, of the 
highest importance that a case of fever should not only be 
managed so as to save the life of the patient, but so con- 
trolled that no permanent injury shall result to the system ; 
and, better still, that the nervous and capillary reaction be 
made so perfect as to swallow up, as it were, any previous 
local debility which may have been set up in the system, 
making the attack of fever prove a positive good to the 
patient, in place of an evil. 

No plan of treating fever, of which I have any know- 
ledge, can be compared in efficacy with the one I have 
described in insuring the above desirable results. And the 
reason of it is plain : it removes the disease without occa- 
sioning any shock to the system, without any expense to 
the vital powers, and without exciting over-action in any 
of the organs ; its action on the system being a general one, 
and one in unison with the natural efforts of nature, viz., 
by directly allaying nervous disturbance, and exciting capil- 
laiy action. Since adopting this plan of treatment in fevers, 
I had seen so many instances of local diseases yielding 
during the progress of the cure, that I afterward acted upon 
the hint ; and, in other cases, purposely brought about the 
same general capillary excitement for the removal of the 
local debility, upon which chronic diseases are mainly de- 
pendent for their continuance. By this means, aided by 
external stimulation, I have succeeded in this city in curing 
many cases of obstinate scrofulous, syphilitic, and mercurial 



HOW TARTAR EMETIC ACTS. 91 

or fever sores, which had resisted all ordinary means for 
years. But I will speak more fully of this subject under 
its proper head. 

HOW TARTAR EMETIC ACTS IN AIDING OR PRODUCING A CRISIS. 

Dr. Fordyce noticed the effects of tartar emetic in pro- 
ducing a state of the system very similar to that in the 
crisis of a paroxysm of fever, and often availed himself of 
this effect of that remedy to obtain a more perfect crisis 
than would otherwise have taken place ; but he was alto- 
gether at a loss to account for the mode of its action. He 
says it was not owing to its emetic or nauseating properties, 
for it succeeded more perfectly in bringing about the condi- 
tion referred to when it occasioned no sensible effect upon 
the stomach. These beneficial effects which he refers to, he 
describes as follows : " The skin becomes softer and moister ; 
sometimes a profuse sweat; the mouth becomes moist; 
secretion is set up in the kidneys and intestinal canal, and 
a sense of ease is felt over the whole body." Now it does 
not appear very hard to explain these effects of tartar 
emetic ; its general operation upon the system is certainly 
that of a powerful depressor of nervous power ; its emetic 
effect is partly owing to its local action on the stomach, and 
partly (perhaps principally) to the general reaction which 
succeeds nervous depression. There is, I suppose, no real 
similarity in the mode of action of the nervous power and 
that of an elastic substance, but there is a striking analogy 
in the apparent phenomena of these operations : the farther 
you bend a steel bow, the greater will be the rebound, unless 
you bend it beyond its power of reaction, when it will either 
break or remain permanently bent. It is so Avith the nerv- 
ous power : a slight depression will be succeeded by incon- 
siderable reaction ; a profound depression by powerful 
reaction ; an overwhelming depressing influence will at once 
break its integrity, or so cripple its powers that it can never 
recover its energy. Tartar emetic is capable of producing 
all these effects. An impression may be produced by it 
upon the nervous system so depressing as to extinguish life 
at once, without an amount of reaction taking place sufficient 



92 on fever: 

even to produce sickness, much less vomiting ; but it may 
also be given so as to impress the nerves so slightly, that 
even nausea is not occasioned ; and the only appreciable 
evidence of reaction is increased capillary action, by which 
all the secretions are augmented. This is a most valuable 
property of that medicine, and may be taken advantage of 
in many cases to serve our purpose most admirably in our 
contest with morbid action. When there is a high state of 
general irritability or actual inflammatory action, I often 
suspend the use of my common fever syrup, and give emetic 
tartar, in sub-nauseating doses, until the active excitement 
is subdued, and then resume the syrup for the purpose of 
establishing permanent capillary action. The mode I prefer 
in which to administer the emetic tartar, is to add a grain to 
a common glass tumbler-full of water, and direct the patient 
to take a tablespoonful every half hour, until very slight 
nausea is produced, and then lengthen the interval. 

OF DELIRIUM IN FEVER. 

Fordyce describes two kinds of delirium which often 
attend continued fevers. One is characterized by halluci- 
nations : the patient fancies he is talking with some person, 
but when spoken to this delusion vanishes, and he will 
answer correctly questions directed to him. This form of 
delirium is often quite violent in the evening and first part 
of the night, but subsides before day, and leaves the patient 
calm and quite rational. It is not attended with much 
stupor or obtuseness of perceptions, feeling, or intellect; 
and there is but little redness or injection of the eyes ; and 
dissection discovers no trace of injury sustained by the 
brain. The second kind has many of the manifestations 
of the first, but differs in this, that the patient is not so 
readily aroused to a state of consciousness, and in the morn- 
ing remission remains more stupid and insensible ; the eye 
is duller and more injected, and the countenance more 
flushed. Dissection always reveals an injected state of the 
vessels of the brain. Fordyce is disposed to believe the 
first kind is purely an affection of the mind ; but this con- 
clusion is arrived at merely because he has not been able 



OF DELIRIUM IN FEVER. . 93 

to conceive of an alteration of the condition of the brain 
which would produce it, and yet leave no trace after death. 
It is very strange that this should have presented any diffi- 
culty to his mind, when he must have known that febrile 
action throughout the entire system consists in merely 
functional derangement ; and that it is only when engorge- 
ment takes place in a particular part, so intense as to de- 
stroy the ability of the capillaries to again contract and so 
resume their natural size, or when actual inflammation has 
been set up, that any trace of the effects of the febrile 
movement can be detected after death. 

The brain is as much concerned in producing thought, 
sensation, and nervous power, as the liver is in making bile, 
or the kidneys urine ; hence, a functional derangement of 
the one will just as certainly and as naturally occasion an 
increased, diminished, perverted, or suspended exercise of 
its appropriate duties as it will in the others. What the 
mind is, independent of organization, we have no means of 
knowing ; all its manifestations are made known to us through 
the medium of organized matter ; and as long as that con- 
nection exists, it can only give us healthy manifestations 
while the medium through which or by which it operates is 
in a healthy condition. It is not surprising, then, that the 
milder grades of delirium should be produced by the same 
capillary inaction and engorgement which give us the func- 
tional derangements which we continually see in the biliary 
and other secretory organs during the progress of a fever ; 
or that dissections should be no more successful in showing 
an altered condition in the one case than in the others. 
All are the result of altered action, produced by a disten- 
sion of the capillaries, which their contractility removes 
after the heart ceases to force the blood into them, leaving 
no marks of their previous condition. But if the distension 
of the capillaries is carried beyond a certain limit, they lose 
the power of contraction, and, in very low grades of fever, 
delirium gives place to coma; and dissection shows the 
capillaries of the brain distended to their utmost capacity 
with black blood ; other organs reveal the same condition. 
But if actual inflammation is set up in the brain, or any 



94 on fever: 

other organ, such alterations are speedily produced as death 
will not entirely remove ; and the second variety of delirium 
described by Fordyce is undoubtedly the result of inflam- 
mation, more or less intense, in this viscus. The symptoms 
indicate this, viz. : the throbbing of the temples, the red- 
ness of the eyes, the suffusion of the face, and the intellect 
remaining unrestored during the morning remission. 

CRITICAL DAYS. 

Fordyce appears to be at a great loss to account for the 
occurrence of what are called critical days in fever ; and, 
after making some very lame attempts at an explanation, 
abandons it as one of the unsolved mysteries connected 
with this disease. Now, if I were to attempt an explana- 
tion, I would do it precisely as I should the appearance of 
ghosts : that is, by denying their existence except in the 
imagination of those who pretend to have seen them. 
The mere statement of the days supposed to be critical 
by those who contend for their existence is proof enough 
of their non-existence. Hippocrates and others desig- 
nate them as follows : The fifth, sixth, seventh, ninth, 
eleventh, thirteenth, fourteenth, seventeenth, twentieth, and 
thirty-first. These are the regular critical days ; then there 
are enumerated others which are called spurious critical 
days, as the eighth, tenth, and eleventh, etc. This is much 
like some of the almanacs that make prognostications of the 
weather : they will say that " rain, more or less, may be 
expected on the third, tenth, seventeenth, and twenty- 
fourth of this month ; the day before, or the day after ;" so 
that if it rains at all, it will come with a good deal of cer- 
tainty upon one of those clays. But the sticklers for critical 
days have left even less chance of a failure, if the fever 
yields at all, for they have embraced nearly the whole time 
consumed by an ordinary case of continued fever, from the 
period of its full development to its usual period of termi- 
nation. 

Now all contagious fevers, we- all admit, naturally run 
through certain stages — which stages consume nearly the 
same time in all cases : the duration of these fevers is, 



CRITICAL DAYS. 95 

therefore, quite uniform; but this kind of termination is 
not what is meant by crisis, and therefore the usual days 
on which these fevers terminate cannot be called critical 
days. If a case of small-pox were to terminate suddenly 
in convalescence on the third or fourth day upon the occur- 
rence of a hemorrhage, sweat, or diarrhoea, these discharges 
would be considered the cause of the sudden breaking up 
of the disease, and hence would be called critical discharges ; 
and if it were perceived that such critical discharges were 
more apt to take place on particular days, these days might 
be properly called critical; but the occurrence of these 
discharges in the course of contagious or self-limited diseases 
has never been known to suspend the disease unless by 
causing death ; hence there are no critical days recognized 
as applying to that class of fevers. 

But other forms of fever, particularly those caused by 
malaria, of which common intermittents are a familiar 
example, seem to have no very definite period to run : if 
left to take their own course, they will continue until the 
powers of the system either sink under their influence, or 
react and arise above them, breaking the chain of morbid 
action which sustained them, or in which they consist. 
Now, whenever the vital forces obtain this ascendency, 
either by their own inherent power, or aided by appropriate 
assistance, then the various secretory organs at once resume 
their functions, and a restoration of the usual discharges of 
excrementitious matter takes place of course, and generally 
in greater quantity than in health : because, first, the vital 
powers have obtained the supremacy by reaction, and this 
reaction generally will go beyond the natural standard; 
and, secondly, there is more excrementitious matter to be 
eliminated than usual, and therefore the same amount of 
vital action will throw off a larger amount of appropriate 
secretions immediately upon the breaking up of a case of 
fever than in health. But is the return of these organs to 
their duty the cause of commencing convalescence, or is it 
the result of some anterior change, and only the effect of 
that change, and therefore not the prime cause of conva- 
lescence, but only a sign of its commencement ? Undoubt- 
7 



96 on fever: 

edly it is the latter. These secretions can be and are often 
set up under the influence of powerful remedies addressed 
immediately to the sensibility of these organs, but conva- 
lescence does not, as a matter of course, follow : on the 
contrary, the general powers of the system are often mate- 
rially prostrated by their action, and the disease left still 
remaining in all its stubbornness. No discharge can there- 
fore be a critical one in the sense in which that word has 
been generally understood, that is, that the discharge itself 
carries off the disease, either by eliminating the peccant 
matter of the ancient humoralists, or by giving vent to the 
black blood of the modern humoralists, or in any other way, 
corresponding Avith any other theory. And yet these dis- 
charges are critical in another and more appropriate sense : 
they indicate that a crisis has arrived, when the powers of 
the system have triumphed over and removed the condition 
in which the febrile movement commenced, and by which it 
was continued. If this error with regard to critical dis- 
charges had been a harmless one, it would not have been 
dwelt upon so lengthily here ; but out of it have grown 
most of the errors in practice by which this formidable 
family of disease have peopled the nations of the dead much 
faster than they would have done under the influence of 
treatment directed by a more enlightened view of the sub- 
ject, or, perhaps, if left to run their course without the 
intervention of any treatment. But what is the change 
which takes place in the condition of the system which gives 
rise to these discharges that may be called critical, because 
indicating that a favorable crisis has arrived in the disease ? 
It must be the removal of that which checked or suspended 
these secretions during the continuance of the febrile move- 
ment. In another place I have endeavored to prove that 
general capillary debility is the condition produced by the 
anterior causes of fever, out of which all the subsequent 
phenomena arise ; and that without this condition there can 
be no such thing produced as the febrile movement. Now, 
a general capillary reaction is exactly what precedes and 
gives rise to general secretory action. When nature cures 
a fever, she does it precisely in this way : the remote cause 



HOW INFLAMMATION MAY CURE FEVER. 97 

either ceases to act upon the nervous system, or the nerves 
cease to be impressed by it, and the nervous disturbance 
gradually subsides, and nervous power gradually increases 
until an amount is sent to the general capillary system 
sufficient to overcome the torpor, debility, or want of action 
in them, which has been the cause of their dilatation, con- 
gestion, and slowness of circulation, from which the scanty, 
depraved, or suspended secretions, and all the other con- 
comitants of fever, have proceeded. Now it is plain enough 
that as soon as this is effected — as soon as the capillaries 
are permanently aroused to action, then, as a consequence, 
the secretions will all be again set up, and all the other 
phenomena which arose from this common cause will also dis- 
appear. Hence, quieting nervous disturbance, increasing nerv- 
ous power, and exciting capillary action, should be the grand 
objects of every effort to break up the febrile movement. 

HOW AN INFLAMMATION MAY CURE A FEVER. 

Fordyce has observed that an inflammation, coming on 
spontaneously, or purposely set up in some part not essen- 
tial to life, during the progress of a fever, sometimes arrests 
the febrile movement, but is wholly unable to tell how this 
beneficial effect is brought about. He very properly dis- 
cards the notion that the cause of fever is attracted by the 
inflammation, and through the medium of the suppurative 
process disappears from the system ; neither can he allow 
that it is done upon the principle of revulsion. To my 
mind, the modus operandi of local inflammation in curing 
fever is just as plain as that of any other agency. It acts 
precisely in the manner of every other successful means — 
viz., by capillary stimulation; the nervous excitement pro- 
duced by the inflammation, by being conveyed to the brain 
and spinal marrow, and thence by the medium of the 
nerves sent out through the whole system, may, when the 
capillary action is not very great, excite them sufficiently 
to bring them up to the healthy standard ; and these being 
once set in motion, the phenomena of fever will as certainly 
subside as will the waters of a mill-pond when the flood- 
gate is raised. But inflammation, in order to be beneficial. 



98 on fever: 

must not be set up in a very vital part, or be very exten- 
sive in parts less vital, or the nervous impression will be so 
powerful as to produce depression of nervous power in 
place of excitement ; hence we perceive the depressing in- 
fluence of active inflammation in the stomach, peritoneum, 
etc.; and hence, also, very large blisters applied to chil- 
dren, or adults of a highly nervous temperament, sometimes 
produce fatal nervous collapse. An inflammation, in order 
to be beneficial, therefore, must not be intense enough to 
create nervous disturbance, or extensive enough to produce 
nervous exhaustion, but just sufficient to occasion a gentle 
nervous excitement. It is, therefore, improper to blister 
while nervous excitement is high ; and it is unavailing or 
pernicious to blister when the nervous power is very low 
and capillary debility profound ; for then it will either not 
produce any sensation, and, consequently, no reflex action, 
and therefore do no good ; or it may produce a powerful 
sensation, and occasion great nervous disturbance, and yet 
be wholly inadequate to arouse the torpid capillaries, and 
the excitement consequently occasion a further exhaustion 
of nervous power. We often meet with this condition of 
the system, particularly in cholera, congestive fever, and in 
profuse hemorrhage : capillary action seems to be wholly 
suspended in the surface and in the extremities — they are 
cold and shrunken, and of a leaden or purple hue ; but yet 
sensibility is at its highest point of exaltation ; the ordi- 
nary warmth of a healthy person's hand often occasions an 
insufferable sensation of heat; sinapisms are intolerable; 
and a blister at this time will prove the cause of most in- 
tense agony, and aid greatly in deepening the collapse. I 
was once called to a gentleman who was laboring under a 
severe attack of cholera ; I found him verging into collapse 
when I arrived, but by the use of judicious means, or by 
the powers of nature, his disease was kept in check more 
than ten hours. At this time two other physicians arrived, 
and upon consultation it was agreed to try the effect of a 
blanket wrung out of hot water and wrapped around his 
person. I did not approve the measure, but as I had 
exhausted my resources and had obtained nothing more 



ACTION OF CONTAGIOUS DISEASES. 99 

than a truce, the enemy still holding entire possession of 
the citadel, I could not reasonably object to a measure 
which two intelligent physicians thought would increase 
the man's chance for life. The measure was therefore 
carried into operation ; but I shall never forget the awful 
expression of agony which the hot blanket occasioned. 
His flesh was as cold as marble when the warmth was ap- 
plied ; but, notwithstanding the heat was not greater than 
was quite bearable to my hand, the patient complained as 
if it had been red-hot coals of fire. But he was not des- 
tined to endure long. A scream, a flounce or two from 
side to side, a few moments of trembling, a gasp . as from 
suffocation, and all was still: the blast had been too strong; 
the taper was blown out. 

HOW DO CONTAGIOUS DISEASES SECURE IMMUNITY FROM THE DIS- 
EASE THEREAFTER? 

A certain class of diseases usually considered contagious, 
it is known, very rarely are produced a second time in full 
force in the same person. Many conjectures have been in- 
dulged in with respect to the cause of exemption. A 
learned professor supposes it may be that the vital sensi- 
bility which is possessed by the mouths of all the capilla- 
ries which afford ingress into the system, and which is 
placed there for the purpose of enabling these vessels to 
choose what is proper to enter the circulation, and refuse 
that which would prove deleterious, may be off their guard 
one time, and allow this subtle enemy to enter ; but hav- 
ing been once caused to suffer severely by this mistake, 
they can never be deceived again by the same agent. But 
this guarding sentinel, whose office it has been supposed is 
to protect the avenues to the circulation from hurtful in- 
truders, is itself but a figment of the brain, having no exist- 
ence anywhere but in the imagination. Of this we have the 
most positive evidence, for we continually meet with in- 
stances in which the most hurtful matters are actually taken 
up by the absorbents. It appears that there is no limit to 
absorption, except that arising from the insolubility of sub- 
stances and their acrid qualities. Very pungent or irritat- 



100 on fever: 

ing matters cannot be absorbed, because they either stimu- 
late the absorbent vessels so intensely as to cause too great 
a contraction to admit of their ingress, or the impression is 
so powerful as to paralyze them and suspend all action ; 
and of course all absorption ceases until a return of vital 
energy takes place. The only conditions therefore that are 
necessary to insure the absorption of the most deadly 
poison as readily as the most healthful nutriment are, that 
it be soluble in water or the juices of the chylopoetic 
organs, if introduced by the mouth, and that it possess no 
powerfully stimulating or irritating properties ; or, if it be 
a gas, that it be mixed sufficiently with the atmospheric 
air to render it respirable. 

But we not only have evidence that the poison of con- 
tagion might be absorbed a second time, but proof positive 
that it often is. It is well known that persons who have 
had small-pox, by being afterwards exposed to the conta- 
gion, often take it in a modified form, and, consequently, the 
poison must have obtained ingress into the system; and 
this is rendered more certain by the fact that unprotected 
persons have taken the true variolous disease by coming in 
contact with one laboring under it in the varioloid form. 
Exemption is not therefore obtained because the poison can- 
not get into the system. The only good reason of which I 
can conceive why persons will ordinarily take these diseases 
but once is, that the poison which causes them is a narcotic 
stimulant. We know that some poisons of that class will 
very rarely fully impress the nervous system more than 
once. Take tobacco, for example : few persons who have 
acquired the habit of chewing this weed but have a vivid 
recollection of the horrible sickness and nervous prostration 
which followed their first initiatory effort at using it. But 
though a second attempt, perhaps, was not made until years 
afterwards, yet no violent effects followed. I had a per- 
sonal acquaintance with a gentleman (a distinguished divine) 
who, from motives of propriety, discontinued the use of 
tobacco after having been a constant user for some years, 
and continued this abstinence for over twenty years ; but, 
being attacked with a dropsical disease, his physician 



CONTINUED ACTION, ETC. 101 

advised him to resume the use of it, and he informed me 
that he used as much the first day of recommencement as 
he had been in the habit of using when he left off the prac- 
tice, and that it affected him no more than formerly. The 
same thing is true of opium and alcoholic drinks, but not to 
the same extent. A full impression, amounting to complete 
intoxication, cannot be reproduced but by increasing the 
dose taken. The very same amount of whiskey which will 
throw a novice upon his back, may be repeated a few days 
subsequently, and will hardly make him stagger; and if 
often repeated, will at last scarcely affect him at all. It is 
just so with the poison of contagion. The first exposure to 
small-pox will produce very violent effects ; a second will 
occasion a much milder effect ; and perhaps the impression 
of the third will not be appreciated. But all contagious 
diseases are not preservative against subsequent attacks ; 
and it will be observed that those which are not, make their 
first impression on some external part, and are therefore not 
of the narcotic kind, are not addressed to the nervous cen- 
tres, and therefore one attack gives no security against a 
second. 



DOES THE CONTINUED ACTION OF THE EEMOTE CAUSE, AFTER THE 
OCCURRENCE OF ] 
WITH ITS CURE? 



OCCURRENCE OF FEVER, INCREASE ITS INTENSITY OR INTERFERE 



Fordyce thinks it does not ; but, with all due deference 
to the opinion of that correct thinker and accurate observer, 
I must differ with him in this conclusion, and for the follow- 
ing reasons : Every physician who has had a large country 
practice, embracing localities differing materially in their 
aptitude for generating malaria, could not have failed to 
observe that those cases of fever which occurred in the 
most malarious districts, and which remained there during 
the attack, were much harder to manage, and more apt to 
relapse, than such as happened to be removed to some 
friend's house in order to be nursed, who lived in a healthier 
vicinity. I resided for some years in McConnelsville, on 
the Muskingum river, in Ohio, and there enjoyed a fine 
opportunity for witnessing examples of the advantage of re- 



102 on fever: 

moving from a sickly to a healthy locality, after the acces- 
sion of an attack of fever. The country on each side of the 
river is high, broken, and well watered ; the banks of the 
river high, and its current rapid, so that it would seem that 
very little malaria ought to have been generated ; and I 
suppose there was not much formed in that particular region. 
But this stream heads up in a very rich, flat, marshy 
country, where all the materials for producing malaria 
abound, and miasmatic diseases are rife almost every year. 
I said that the Muskingum had a rapid current, but there 
was a great difference in its rapidity at different points : for 
a mile, or perhaps several miles, it was very gentle, and 
then for a shorter distance it was exceedingly rapid : (I 
speak in the past tense, for at present all parts are alike, 
the river having been dammed so as to produce slack-water 
navigation.) At the time I lived there, there were many 
salt-works in operation along the river, which gave employ- 
ment to a great number of hands ; who, added to other 
inhabitants, made the valley of the river quite populous. 
Now, those who worked or resided on the bank opposite to 
where the water ran gently, very rarely became sick ; but 
fevers were exceedingly common among those who occu- 
pied a position opposite the rapids ; and especially after a 
rise of water succeeding a hot, dry spell of weather. As 
many of the operatives at the salt-works were young men 
whose relatives lived among the adjacent hills, it was very 
common to have them removed there when taken sick ; and 
I discovered a very marked difference in the stubbornness 
of the disease in those who remained, and those who " fled 
to the mountains ;" and relapses were very common among 
the former, and rare among the latter. And here I would 
call attention to a fact with regard to malaria that I have not 
seen noticed — that is, that it may be absorbed by or mingle 
with water, and be carried by the current a long distance, 
and then set free by agitation and become exceedingly 
active. But to return to the subject, that the cause of 
disease by continuing to act upon the system will increase 
the violence of a fever, and invite relapses : Some years 
since, while practicing in Wilson county, I was called to 



CONTINUED ACTION, ETC. 103 

attend on a family which resided near an extensive mill- 
pond on Ronnd Lick Creek : one after another was attacked, 
and all proved exceedingly intractable to the influence of 
remedies, and all suffered frequent relapses, until it became 
quite evident that no effort I could make would save them 
from fatal prostration, if they remained under the depressing 
influence of that malarious atmosphere. I accordingly recom- 
mended a change of location, although three of the family 
were then not able to turn themselves in bed ; but they 
were lifted on their beds into a wagon, and conveyed about 
four miles, to the residence of the gentleman's father, which 
was situated in a locality proverbially clear of malaria. 
The change was not only profitable, but remarkable ; and, 
with but very little further medication, all rapidly recovered. 
I could narrate many other examples equally as striking as 
the above, which have come under my own observation; 
but every observer can doubtless furnish examples from his 
own memory which will be amply sufficient to prove my 
position. 

But is this true of the action of the remote cause of all 
other fevers ? Not perhaps to the same extent. In epi- 
demic fevers it is equally true ; but in contagious fevers it 
is not. In these, the remote cause, after having once set 
up the chain of morbid action which characterizes the 
peculiar disease, cannot, by continuing to act, set up a new 
series of morbid movements ; but it can do this : it can 
exert a depressing influence upon the system, which will 
lessen its ability to successfully bear up under the disease 
while it runs its course. It appears that during the pro- 
gress of every febrile disease there is some kind of eman- 
ation proceeds from the person of the patient, which, if it 
does not excite the same identical disease in another, will 
at least prove a means of aggravating any other form of 
fever under which the individual may be laboring at the 
time. A number of fever patients, therefore, in the same 
house, will stand a less chance of recovery than if they 
were each in a different house, although no two may have 
the same form of fever. This is the only rational cause 
that can be assigned for a greater mortality in hospitals 



104 on fever: 

than in private practice. It will not do to say that other 
circumstances are less favorable ; that there is less ventila- 
tion, fewer comforts, more dirt, inferior nursing, or a greater 
lack of medical skill; for the very reverse of all this is 
generally true. 

Every physician who does a general practice in a city, 
knows that a large per cent, of his patients are among the 
poor and degraded, where there is neither good air, good 
nursing, nor good food, but plenty of filth, and very few 
comforts of any kind ; yet even among these he will save a 
greater per cent, of his patients than is saved in the best- 
regulated hospitals. The reason is, that in the hospital 
there are many fever patients, every one of whom is con- 
tinually throwing off a peculiar malaria to poison the atmo- 
sphere, and depress the nervous power, so as to cripple the 
recuperative energies of the system, making it more difficult 
to struggle with the particular disease under which it is 
laboring. It is therefore evident that the remote cause of 
fever does continue to act injuriously after the fever is set 
up ; and it is therefore important to the safe recovery of 
the patient, and as a means of lessening the chances of those 
who are with him of taking the disease, that the remote 
cause be destroyed, if indeed it can be. And from a care- 
ful observation of passing events since I introduced my 
present plan of treating fevers, I have perceived sufficient 
evidence to convince me that this plan destroys or neutral- 
izes the remote cause of fevers, as the very first step to- 
wards its cure. 

My attention was first directed to this subject while en- 
gaged in treating dysentery, some years since, on the Caney 
Fork of the Cumberland river. That disease was highly 
epidemic at the time within certain bounds, not spreading 
all over the country uniformly and at once, but commencing 
at certain points, and extending in certain directions. The 
epidemic influence was so intense that, as the cause seemed 
to extend, nearly every inhabitant was brought under its 
control, and one after another of a family were stricken 
down, until nearly every one had an attack. But I dis- 
covered that where I was called to take charge of the new 



CONTINUED ACTION, ETC. 105 

cases in a family, and put them upon the plan of treatment 
which I believed was calculated to not only control the dis- 
ease, but also destroy the remote cause, it rarely happened 
that any other new case occurred in the family, and no new 
attack took place in any case in which I was called to treat 
the first patient that sickened with the disease. 

Since that time, I have seen the use of the same means 
followed by the same results with regard to typhoid fever. 
I recollect of no case in which a second attack has happened 
in the same family under my management. In a conversa- 
tion held with a medical student a short time since upon the 
subject, he observed that if what I said was true, it would 
curtail the whole amount of medical practice materially; 
that, by shortening the usual period of treating fevers more 
than one-half, and then preventing, in a good measure, some 
of the most troublesome varieties from extending, it would 
diminish the fever practice to a ruinous extent to the phy- 
sician. Well, let it be so. The people, I suspect, would 
hardly be willing to suffer sickness merely to accommodate 
physicians ; and then it will work no real loss to the practi- 
tioner himself, even to lose his calling entirely ; for I hold 
it to be certain, that any man who has intelligence, judg- 
ment, and industry sufficient to constitute him a good phy- 
sician, can make more money at almost any thing else to 
which he may choose to devote his energies. I have known 
many physicians who, after scuffling for years with poverty 
in the profession, at length turn their attention to something 
else, and make a rise in the world in a short time. But 
whether it increase or diminish the profits of the profession, 
will never operate as a reason for its rejection or adoption — 
this will be settled by the evidence of its truth ; for to the 
honor of the profession be it said, it has never been back- 
ward in adopting every means which gave good promise of 
curtailing human misery. But I have somewhat wandered 
from the subject. I think I have given good reasons for 
believing that the continued action of the remote cause 
of fever does render that disease difficult to cure, and 
more liable to relapse. These reasons, in brief, are, that 
malarious fevers do not yield as readily to remedies while 



106 on fever: 

the patient remains in the infected district, as when removed 
to a locality where the poison does not exist, and that re- 
lapses are much more common under the former than under 
the latter circumstances ; that in hospital practice, where 
the apparent circumstances are much better than in pauper 
practice in a city, the mortality is generally larger, showing 
that the malaria generated by fever patients operates inju- 
riously to the recovery of others, when a number are con- 
fined within the same walls. I will add, that even other 
than fever patients feel the influence of this malaria, when 
confined in the same atmosphere with a number of fever 
patients — ulcers are difficult to heal, bones unite tardily, 
the effects of capital surgical operations are more fatal, 
etc., etc. 

And, further, that aborting febrile diseases, or breaking 
them up in their earlier stages, lessens the liability of those 
around them to take the disease. 

HOW DOES QUININE CURE INTERMITTENTS ? 

It does it, either by destroying the malaria or by neutral- 
izing its power, or by removing the condition of the system 
produced by the action of the malaria, from which the fever 
arises. That it does not act in either of the first ways 
mentioned is proven by the fact that it does not always 
succeed. For it is evident that if it is capable of destroy- 
ing the malaria, or so changing its nature as to deprive it 
of that quality which impresses the system injuriously, it 
must do it always. Whether malaria be a poisonous gas or 
organized existence — whether vegetable, animal, or chemi- 
cal — this would be the case ; any substance which unites 
with another chemically, so as to neutralize it or change its 
nature, will always act thus ; and any thing which will 
destroy the life of any particular species of animal or vege- 
table existence will do it every time, if given in sufficient 
quantity or applied in sufficient force. It follows, that if 
quinine destroyed the cause of fever, or was an antidote to 
the effects of that poison, it would never fail in its opera- 
tion. But it does fail occasionally, under the best manage- 
ment ; and even when it succeeds in breaking up the disease, 



HOW DOES QUININE CURE INTERMITTENS ? 107 

it often returns again, and after the quinine is repeated a 
few times, it generally wholly loses its power : this would 
not be the case if it acted as a neutralizing chemical agent, 
or if it acted as a poison to the organic existences which 
compose malaria. It therefore does not act by destroying 
the malaria, or by neutralizing it. It remains, then, that it 
does act by removing the condition of the system produced 
by the malaria, out of which the fever arises, or in which it 
consists, for there is no other conceivable mode by which it 
can act. But the evidence of its acting in this way doer> 
not rest merely upon the fact that we cannot explain ita 
modus operandi in any other way, but is based upon its per- 
ceptible effects upon the system, and the analogy of these 
effects with those produced by other remedies, the mode of 
action of which is well understood. Now what are the 
sensible effects of quinine ? I once took five grains of this 
medicine, when in good health, on purpose to ascertain, if 
possible, its mode of action on the system, and I found its 
sensible effect to be that of a pure nervous stimulant. It 
produced that state of the system, in a high degree, which 
we call nervousness — a sense of agitation, slight quiverings 
of the muscles, some intolerance of light, increased sensi- 
bility to sounds ; and even imaginary sounds were heard, as 
of distant ringing of bells. Besides these, there was wake- 
fulness, and a very uncomfortable restlessness ; and these 
sensations remained in force for over twenty-four hours. 
The reason such a moderate dose produced so much effect 
was, that there was no nervous depression in my system to 
overcome, as there is in fever ; on the contrary, I am natu- 
rally of a nervous temperament, and easily impressed by 
all nervous stimulants. I have not given this description 
of the sensations produced by quinine in my own person 
because they were peculiar, but because they are exactly 
what are described as arising from the influence of the 
medicine by others, who have taken it to break up a chill ; 
showing that its effects upon the healthy orgasm are the 
very same which it produces in disease ; and it may be 
noted, that if it fails to produce these, its natural effects, in 
some considerable degree, it also fails in effecting the object 



108 on fever: 

for which it is administered. But quinine not only acts 
like other nervous stimulants, but other nervous stimulants 
act like it, that is, they accomplish the same object. It is 
well known that opium will prevent a chill, with almost as 
much certainty as quinine ; so will ardent spirits, so will 
the cold douche, so will a powerful mental excitement. 
These, it is true, are not so permanent in their effects as 
quinine — the reason for which will be given presently — but, 
as far as their sensible effects are concerned, they act very 
similarly : all produce an agitation of the nervous system, 
muscular tremors, wakefulness, giddiness of the head, and 
an exaltation of the senses. I mean they do these when 
applied in a certain force — all may operate with such over- 
whelming power as to suspend sensation, but all when 
operating with moderate power, like quinine, increase nerv- 
ous power, and exalt sensibility. In what, then, consists 
the superior power of quinine over other nervous stimu- 
lants in breaking up intermittent fever ? It is because it 
is not only a powerful nervous stimulant, but it is a perma- 
nent one, and nothing else. It is not evanescent in its 
effects, like the cold douche and mental excitement, nor does 
it possess, like opium and other medicines of that class, 
sedative or depressing properties, by which, after exciting, 
they depress nervous power, thereby increasing the nervous 
debility, which causes a chill : quinine, by bringing about a 
high state of nervous excitement, and continuing it for a 
considerable time, in consequence of the increased amount 
of nervous power which is sent out to the whole system, 
often causes such a perfect reaction in the capillary vessels, 
that they do not relapse again into torpor, and consequently 
a permanent cure of the fever is effected. But sometimes 
the excitement produced by quinine amounts to actual 
nervous disturbance, succeeded by depression, in which case 
the capillary debility is increased, and then its use proves 
an entire failure. Taking this view of the subject, I am in 
the habit of giving but a moderate dose of quinine, just 
enough to impress the nervous system, say from four to six 
grains, and at the same time give my fever syrup, to keep 
down nervous disturbance, and to increase capillary action. 



MODUS OPERANDI OF TOPICAL REMEDIES. 109 

In this way, I have generally succeeded in breaking up 
intermittent fever with a single moderate dose of quinine ; 
for if the syrup is continued for several days after the chill 
is broken, there is little danger of its returning. This mode 
of treating intermittents has several advantages : it is more 
certain, it produces no unpleasant effects, and it is much 
cheaper. 

MODUS OPERANDI OF TOPICAL [LOCAL] REMEDIES. 

Fordyce, (p. 304,) in speaking of the known benefits 
which often arise from cupping or leeching the temples, 
when a patient is suffering in the head, or in delirium during 
fever, observes, that it cannot be accounted for by the 
mere amount of blood drawn from the general circulation, 
or from any direct relief to the vessels immediately con- 
gested, as they are situated within the brain, and there is 
no very intimate connection between the internal and exter- 
nal circulation of the head ; hence he adds : " The reason 
why such topical evacuations by bleeding carry off or 
diminish the delirium or pain in the head, or even sometimes 
the whole fever, is consequently wholly unknown to the 
author." The same difficulty will present itself in account- 
ing for the beneficial effects of other topical means — such 
as dry-cupping, sinapisms, stimulating liniments, blisters, 
etc. These often prove as beneficial as drawing a little blood 
by cups or leeches, and they undoubtedly operate upon the 
same principle — all act by producing a stimulant effect 
through the medium of nervous connection or association. 
Distant parts of the body are known to be closely asso- 
ciated by nervous influence — the uterus and the mammce, 
[breasts,] the parotid gland and the testes, mucous surfaces 
and their external opening ; and all internal parts with the 
external surface immediately opposite. Some of these 
associations, among which is the last, are not owing to 
direct nervous communication, but are dependent upon that 
connection which exists between the nerves of the asso- 
ciated parts in the brain, spinal marrow, or some other cen- 
tre of nervous influence, as the great plexus and ganglia. 
Why there should be a close nervous association between 



110 ON FEVER: 

the skin and the deep-seated parts immediately under it, we 
cannot tell, except that it was so arranged by our benefi- 
cent Creator for the express purpose of enabling us to pro- 
duce remedial effects upon parts beyond our reach, by 
applications addressed to those parts within our reach. 
This appears to be a sufficient reason for the association, 
and we can perceive no other, as these parts are not at all 
concerned with each other in performing their ordinary 
functions. The mode of operation of topical remedies 
appears, then, to be as follows : a blister, for example, is 
applied over the seat of an internal inflammation ; it acts 
as a powerful stimulus to the cutaneous capillaries, and the 
impression, being conveyed by the nerves of organic life, 
with which the part is supplied, to the nervous centre from 
which they take their rise, is sent by reflex action along 
the same kind of nerves to the deep-seated part, and be- 
comes a stimulus to its capillaries and arouses them to 
healthy action. I say nerves of organic life in the above 
connection, to distinguish them from nerves of sensation, 
for these appear to have little or nothing to do with the 
beneficial operation of a blister in relieving deep-seated in- 
flammation or congestion. This is proven, first, by the fact 
that blisters often draw well without producing any sensa- 
tion at all, and yet produce their full remedial effect ; and, 
secondly, blisters often occasion intense sensation while 
producing but very slight capillary excitement in the part, 
and without any benefit to the internal inflammation or 
congestion. We are all familiar with examples of this kind 
in conditions of great capillary debility, connected with a 
high state of nervous sensibility, as in cholera, congestive 
chills, etc. My observations have led me to the conclusion, 
that the benefit derived from a blister, or any other stimu- 
lating topical remedy, is always in an inverse ratio to the 
suffering it occasions the patient ; and acting upon this 
idea, I am in the habit, when I think it best to employ 
them in a case in which the sensibility of the nerves of 
sensation is exalted, of subduing it as much as possible by 
opiates or anodynes ; for it appears that the same kind of 
impression which is transmitted to the nervous centre, is 



HOW DOES TURPENTINE ACT? Ill 

sent, by reflex action, to the associating organ or part. 
Hence, if it be increased sensation which predominates, the 
only effect of the local application is to increase the sensi- 
bility of the associating part, and, consequently, augment 
the suffering ; but if the matter is so managed that but 
little impression is made by the topical stimulant upon the 
nerves of sensation, and capillary excitement greatly pre- 
ponderates, then the effect upon the internal inflammation 
is most strikingly beneficial; the capillaries of the part 
being roused to action, relieving the engorgement which 
occasioned the nervous suffering and other mischiefs refera- 
ble to capillary distension, without any expense of suffer- 
ing to the patient, or any danger of increasing the general 
morbid action by getting up an extensive nervous dis- 
turbance. 

It was said above, that the same impression which is 
made upon any one part by a topical application, will by 
reflex action be also produced in the associating part. 
This will at once explain the operation of every kind of 
remedy of that class. It is in this way that a soothing 
poultice to the abdomen relieves pain or spasm in the 
bowels ; in this way chloroform liniment, applied to the 
surface of limbs tortured with the aches of the first stage 
of fever, will allay the distress in the bones, sinews, and 
muscles, as by enchantment ; it is in this way that blisters 
or strong rubefacients, applied to the breasts of a female 
suffering from suppressed menstruation, will excite the 
capillaries of the uterus, and cause it to perform its func- 
tion ; and in this way an anodyne poultice, applied to the 
same parts, will transmit its soothing effects to the womb, 
and quiet the pains attendant on difficult menstruation. 

HOW DO SPIRITS OF TURPENTINE ACT BENEFICIALLY IN TYPHOID 

FEVER? 

So many intelligent physicians have given their united 
testimony in favor of the use of turpentine in typhoid fever, 
that we a*re compelled to believe that it does possess some 
useful properties, suitable to control this particular form of 
diseased action, or at least some of its stages. 
8 



112 ON fever: 

But writers differ widely as to the time of administering 
it, and the amount prescribed ; but most of them agree in 
giving it in the second stage of the disease, when there is 
considerable redness of the tongue, irritability of the bowels, 
and tenderness of the abdomen, in small doses ; and more 
freely in the third stage, when there is low delirium, sub- 
sultus tendinum, [jerking of the leaders,] etc. My views 
of the nature of the febrile movement in general, and the con- 
dition of the nervous system in particular, in this disease, 
as well as my experience, would lead me to prescribe this 
remedy, under certain restrictions, in all its stages. Before 
adopting my present mode of practice, I relied more upon 
this than on any other remedy, and yet occasionally pre- 
scribe it, especially when called to a case which has already 
run into the second stage ; it therefore is pertinent that I 
inform the reader with what view I administer it, and what 
advantage I expect to derive from it ; for I protest against 
giving any thing in disease for which I cannot assign a good 
reason. 

In another part of this work, I have said that turpentine 
enters the circulation and acts as a direct stimulant to the 
capillaries in general, and to those of the kidneys in par- 
ticular; but it does more "than this : it is a powerful stimulus 
to the nervous centres, and greatly increases general inner- 
vation. In typhoid fever, nervous power is deficient, as 
well as capillary action too low ; therefore we can see at 
once that turpentine may be used in it with great advan- 
tage. But it does still more : in this fever, there is always 
more or less intestinal irritation, and often inflammation; 
now we know, from microscopic observation, that the capil- 
laries are torpid in these states of disease, and observation 
has proven that turpentine, as a local application, is an 
excellent excitant to bring up the action of the capillaries 
to the healthy standard; hence it has become a popular 
application to burns and sores. Turpentine, then, acts 
beneficially in typhoid fever in the following ways : 

First, it tends to relieve the local irritation or inflamma- 
tion in the alimentary canal. But for this purpose it should 
not be given undiluted, or even in water, as, by not mixing 



HOW DOES TURPENTINE ACT? 113 

with the water, it will still strike the walls of the stomach 
in its full strength, and injure its coats ; it should always 
be combined with syrup, or mucilage, or olive oil, so as to 
cover its acrimony. 

The second indication for which it may be given, is to 
excite general capillary action. That it has this effect, in 
a very considerable degree, is evident from the improved 
appearance of the surface which often follows its exhibition 
in very low conditions of the system, and the general 
restoration of the secretory action which we also often see 
follow its administration, known by the tongue and mouth 
losing their dryness, the skin becoming more pliant, and by 
a more abundant flow of urine. For this purpose, it should 
be given in small doses, largely diluted with some bland 
material, which will favor its absorption ; for if given in too 
large doses, and especially if undiluted, it will irritate the 
absorbent vessels so as to cause their mouths to contract 
and prevent absorption, or, if it enters the circulation in 
too much force, it may over-stimulate the kidneys, it being 
specifically directed to these organs. The indiscriminate 
and almost reckless use that has of late years been made of 
this remedy in typhoid fever and dysentery, has led to 
many cases of incurable debility in the kidneys, occasioned 
by over-stimulation ; so that we should recollect, that while 
we are curing a man of an acute disease, we will not lay 
him under much obligation to us if we entail on him some 
irremediable injury, and especially when all the advantages 
of the remedy can be obtained without any of its disadvan- 
tages. But turpentine, in the third place, acts upon the 
nervous system. That it does, is evident from its beneficial 
effects in low stages of fever, in quieting nervous restless- 
ness, subduing subsultus tendinum, and relieving low, mut- 
tering delirium. That it is especially a nerve stimulant and 
not a sedative, is proven by its increasing nervous disturb- 
ance, headache, and delirium, when these arise from over- 
action or excitement. We, therefore, should be guarded in 
its administration ; withholding it altogether when there is 
evidence of over-action in the nervous centres ; and even 
in cases of under-action we should be careful not to impress 



114 ON FEVER : 

the nervous centres too powerfully, or we may exhaust the 
vital impressibility and defeat our purpose, or we may pro- 
duce so much nervous reaction as to cause nervous disturb- 
ance, which some, not being able to detect, have considered 
a good reason for pushing the remedy still farther, until, if 
the patients survived the shock, they were permanently 
injured by having partial paralysis or other forms of nervous 
lesion entailed on them for life. 

WHY DO MERCURIALS ACT INJURIOUSLY IN TYPHOID FEVER ? 

I answer, because they have a tendency to produce the 
typhoid condition. 

Now in what does the typhoid condition consist ? That 
is, what distinguishes typhoid from other fevers ? It most 
assuredly is the want of nervous power, manifested in 
many ways not necessary here to enumerate, but in no 
way more strikingly. than by a deficiency of fibrin in the 
blood. This material seems to be the most difficult to 
elaborate of any of the constituents of the system — the 
very highest effort of vital action is required to produce it; 
hence, in all cases in which nervous power is low, fibrin is 
found to be deficient in the blood ; and in all cases in which 
fibrin is deficient, the repairing or healing process does not 
take place. Whether this is for want of fibrin, or from the 
cause which produces a want of fibrin, viz., a low state of 
vital action, is not known. From this cause, blisters drawn 
in an advanced stage of typhoid fever often refuse to heal; 
and from this cause ulcerations so often prove troublesome 
in the intestinal coats in typhoid fever. Dr. T. L. Maddin, 
of this city, read a paper before the State Medical Society 
in the spring of 1856, which was published in the May num- 
ber of the Nashville Journal of Medicine and Surgery, in 
which he gave, as I believe, the true pathology of these 
ulcerations, viz. : that Peyer's and the solitary glands of the 
intestines have a peculiar construction, being nothing more 
than minute vesicles formed under the epithelium [scarf- 
skin] of the bowels, having no orifices, and bursting when 
they become distended, and so causing a minute lesion of 
continuity in the epithelium ; repaired, it is true, with very 



MERCURIALS IN TYPHOID FEVER. 115 

slight effort in health, but which, in the typhoid condition, 
when nervous power is low, and the reparative effort at 
zero, serves as a beginning-point for the destructive process 
of ulceration. And as these glands or vesicles, when they 
discharge their contents, become obliterated in the natural 
condition of the system, and others form in their place, to 
become full and burst in their turn, keeping up a regular 
succession, so in typhoid fever it is found that a like suc- 
cession of ulcers is formed — post mortems [examinations 
after death] having revealed the fact that ulcers in every 
stage of development were present from the size of a 
mustard-seed to that of a hen's egg, and fully perforating 
the coats of the bowel, the reparative process being entirely 
suspended. Now, what are the facts with regard to the 
influence of the constitutional effects of mercury? Does 
not observation prove that it does the same thing ? The 
best writers acknowledge that it lessens nervous power ; it 
also occasions a loss of fibrin in the blood, and cripples the 
recuperative powers so that the reparative process is sus- 
pended, and ulcers will not heal. It is true that, when the 
inflammatory process is set up in the salivary glands, an 
amount of excitement is conveyed to the nervous centres 
sufficient to whip up a forced state of nervous power ade- 
quate to manufacture fibrin, but not out of the raw material; 
not from nutriment taken in, but by breaking down the 
tissues of the body and appropriating the fibrin which 
entered into them, throwing off the albumen and salts at 
the mouth. And sapient physicians have resorted to this 
destructive process to force a little fibrin into the circula- 
tion, but oftener killed their patients in trying. How much 
more philosophical it is to go to work with such means as 
will increase nervous power and restore capillary action, so 
that fibrin may be manufactured from appropriate food ! 

The inquiry will naturally arise, Why do so many really 
intelligent physicians persist in giving mercurials in typhoid 
fever ? One reason is, that they were taught to give it — 
all the fathers gave it : Cullen, Rush, Chapman, Cooke, and 
all the lesser lights, relied on it as the remedy in fevers in 
general. Another reason is, that in most fevers it actually 



116 on fever: 

does do good under proper management, and physicians are 
slow to believe that a remedy which acts beneficially in other 
fevers will act the reverse in this. 

Mercurials possess one property of action which, so far 
as it goes, renders them exceedingly appropriate in fevers : 
they do increase capillary action; given in the proper 
manner, no remedies can act finer in this respect; hence 
they excite all the secretions ; and those who look no farther 
for the source of mischief in disease than the most obvious 
effects, naturally enough suppose that the suspension of 
secretions is the disease, and to restore them is to cure it. 
But if they would recollect that it is the want of nervous 
power that has occasioned capillary debility, and this in turn 
the diminished secretion, they would never resort to a ner- 
vous debilitant to remove the difficulty, but would rather call 
into requisition such generators of nervous power as turpen- 
tine, camphor, ammonia, etc., but especially sassafras, 
piperin, and valerian. A distinguished physician who wit- 
nessed the happy manner in which these articles control 
typhoid fever, (having watched the progress of a case under 
my treatment,) inquired of me if it was not probable that 
the sassafras operated in the same way as turpentine, (he 
having great confidence in turpentine.) This conjecture 
was undoubtedly well founded : turpentine is a nervous 
stimulant, and so is sassafras ; both increase nervous power, 
and in this way both are valuable remedies in typhoid 
fever ; but the sassafras is preferable, because it is the best 
nervous stimulant, and because it never acts as a nervous 
irritant, as turpentine sometimes does, and never acts inju- 
riously upon any of the organs, as turpentine occasionally 
does upon the kidneys ; and then sassafras possesses the 
rare property of destroying or counteracting the effects of 
narcotics, and in this way prevents any further action of 
the remote cause, so that between it and turpentine and 
mercury the case stands this way : 

Mercury increases capillary action and excites the secre- 
tions, but depresses nervous power, which is already 
deficient, and in this way increases the deficiency of fibrin, 
and destroys the recuperative powers so that the reparative 



MERCURIALS IN TYPHOID FEVER. 117 

process cannot be set up, and the patient wears out, or 
destructive absorption perforates his bowels, and he dies 
suddenly from the contents entering the cavity of the abdo- 
men. 

Turpentine acts also as a capillary stimulant, and, in place 
of depressing, elevates nervous power, and thereby favors 
the production of fibrin, and aids the restorative efforts of 
the system, so that these lesions in the intestinal epithelium 
are healed, and the process of destructive absorption stayed. 
It is however liable to over-stimulate the nervous centres, 
get up nervous disturbance, produce over-action in the 
kidneys, and entail debility on those organs. 

Sassafras does whatever the turpentine can do that is 
beneficial, and never does harm, so that it is to be preferred 
of the two, and, with the aid of piperin and valerian, will 
do pretty much all that is required to be done in typhoid 
or any other fever. 



118 on fever: 



CHAPTER VI. 

PARTICULAR FEVERS. 

I will now take up the individual fevers, and point out 
the diagnostic symptoms of each, and the variations of treat- 
ment which I have found necessary in adapting my general 
plan of treatment to each variety and stage, and the various 
minor helps which serve to meet complications, remove 
annoyances, and increase the efficacy of the principal 
remedies ; and will also give the treatment of the latest and 
best accredited authors, pointing out what I think objection- 
able, and then leave the reader at liberty to adopt that 
which he thinks most reasonable. And, as being the most 
important on account of its ranging over a wider territory, 
and being more intractable to the influence of common 
remedies, I will first take up 

TYPHOID FEVER. 

The forming stage of this fever is generally more pro- 
tracted than any other. For many days, or even weeks, 
the patient is sensible of not being quite as well as usual ; 
has less energy ; less vivacity ; a more capricious appetite ; 
has some irregularity of the bowels ; sleep more disturbed, 
and not so refreshing as usual ; finally, pains strike him of 
a peculiar kind, often assuming the form of a crick in the 
neck, or aching of the head, and soreness about its junction 
with the neck. His feeling of discomfort gradually becomes 
more decided ; and, although he is still often unable to refer 
his illness to any particular point, yet he is conscious of 
being very sick, but perhaps still mopes about for a few 
days longer, expecting every day to get better. Friends 



TYPHOID FEVER. 119 

frequently look upon it as an attack of common cold, and 
administer sweating remedies to throw it off; but although 
he perspires copiously, he is not at all relieved, and they 
next usually conclude to give a purgative to work the cold 
off by the bowels. This also operates with unusual power, 
and the bowels continue to run off with watery discharges 
long after the medicine has spent its force. By this time 
the patient is decidedly worse, and, if a negro, he covers 
himself up in bed, even should the weather be warm, and 
sleeps or is in a stupid condition, which might be easily 
mistaken for sullenness. Arouse him and ask him what is 
the matter, and he will probably say, Nothing : ask him 
why he is in bed then, and he will say he feels too weak 
to work ; if he complains, and you inquire where his misery 
is, he will answer, All over. If a white man, he will proba- 
bly be found sitting with the family, and will apologize for 
neglecting business upon so trivial an occasion ; observes 
that he has felt "out of sorts" for several days. His pulse 
is little more frequent than natural, and the surface, espe- 
cially of the body, a trifle too hot, and the extremities 
rather too cool ; his countenance looks tired and expression- 
less ; tongue furred, and unusually white, as though it lacked 
blood, or presents the hue of venous blood. Ask him if he 
has tenderness of the abdomen, and he will commonly say 
No ; but upon making pressure just above the umbilicus, 
[navel,] or a little to the right, you will discover that he will 
flinch; pressure along the spine will commonly detect 
several points of tenderness ; his chief complaint however 
is of weakness, which he attributes to the operation of the 
purgative, if he has taken one. 

If the disease is suffered to progress, the giddiness of the 
head will be changed for severe pain, delirium, or stupor as 
from intoxication. There is now decided tenderness the 
whole length of the spine ; the tenderness of the abdomen 
is also considerably increased, attended with more or less 
fulness ; the heat of the trunk is augmented, and the pulse 
accelerated, and is small and wiry under the touch ; tongue 
thickly coated in the middle, but rather clean at the edges, 
and of a deeper red ; in putting it out it assumes a pointed 



120 on fever: 

form with a slight elevation of the edges, and it will often 
quiver like a leaf in the wind. The tongue is not however 
red and pointed in every case ; sometimes it is unusually 
white, as though it lacked blood, and is spread out much 
broader than natural. There is usually some diarrhoea ; at 
least, if any purgative has been given, it has run off with 
watery discharges. The heat, though not generally so 
great in this fever as in some others, is more persistent, 
varying but little for many days together. 

You who have ever seen a case of typhoid fever, will 
readily recognize the likeness I have drawn. Now what 
kind of lesion does this group of symptoms indicate ? Do 
they not all point unmistakably to derangement of the 
nervous system, forcing the conclusion that this disease 
has its primary foundation in the disturbance of the nervous 
centres ? Every characteristic manifestation of this fever 
from first to last indicates this, viz., weariness, lassitude, 
cramping pains, giddiness, the wry neck, the trembling 
tongue, the peculiar fretful pulse, the fitful alternations of 
heat and cold, and subsequently the flashes of fiery heat, 
. the delirium, subsultus tendinum ; and even the red tongue, 
the irritable bowels, and the rose-colored eruption, as I will 
show hereafter, all grow out of disturbance of the nervous 
centres, which disturbance is evidently the result of the 
action of the remote cause, as they precede local disturb- 
ances, and therefore cannot he produced by them. Hence 
this disease has often been known by the term nervous 
fever. 

The capillary debility, and consequent engorgement, 
being more slowly produced in this than any other fever, 
the reaction is also more tardy in taking place, but, when 
set up, is proportionally more persistent, and the disease 
has therefore been called the " continued fever." The red 
tongue and intestinal irritation have claimed the attention 
of others, and they, taking these symptoms as indicating 
the seat of the disease to be in the stomach and bowels, 
have named it " enteric fever," or gastro-enteritis. 

But these are by no means the first symptoms of the 
disease, but come on in its progress, and are therefore an 



TREATMENT OF TYPHOID. 121 

effect of some other lesion : they are not even peculiar to 
thife disease, for we find them fully as prominent in other 
diseases known to be the result of great nervous disturb- 
ance, such as fever from dentition, [teething,] from intes- 
tinal worms, from painful or difficult menstruation, from 
conception, etc. Every one who has seen much disease 
has seen the red tongue, the irritable stomach and bowels, 
and the great impressibility of the system to the influence 
of medicine, as fully developed in these and kindred cases, 
known to arise from nervous disturbance, as they ever have 
in typhoid fever. 

In the progress of this disease there often appears a 
peculiar eruption on the surface about the epigastrium, [pit 
of the stomach,] and also internally in the neighborhood 
of Peyer's glands, which has induced many to class it 
among the eruptive diseases, such as scarlatina and measles, 
and that, like them, it is contagious and self-limited. But 
we have many other examples of peculiar eruptions origin- 
ating from great nervous disturbances, such as arise from 
over-doses of narcotic stimulants, poisonous fish, lobsters, 
mushrooms, etc.; and it is not unphilosophical to suppose 
that the eruption attending the true specific contagious 
diseases is the result of a similar cause, viz., that the 
remote cause of these diseases, whether animalcule or 
gaseous, is of the nature of a narcotic stimulant or nerve- 
poison, and the eruption is the consequence of the nervous 
disturbance. It will be perceived, therefore, that I do not 
deny that typhoid fever is an eruptive disease, or that it is 
contagious ; all I contend for is, that it is the result of a 
narcotic poison, either organic or gaseous, acting upon the 
nervous centres. 

I can offer very little upon the treatment of this disease, 
except what could be gathered from the observations which 
may be found upon this subject in the preceding pages ; 
however, to bring the subject directly before the reader in 
a more condensed form, and enable him to understand my 
manner of using the principal remedies, and the particular 
helps which should be called in by way of meeting the 
various difficulties which present themselves, from time to 



122 on fevee: 

time, in the progress of a case of typhoid fever, I will now 
proceed to take up a case representing its most usual form, 
and give a kind of programme of my method of procedure. 

All fevers, as I have before observed, are very similar in 
their inception ; therefore, when I am called to see a case 
in the forming stage, I think it best not to decide what 
form I may have to treat. If interrogated upon the sub- 
ject, I answer that the patient has either taken cold or is 
about to have some sort of fever, and that I cannot name it 
until it is further developed. In this stage, it is usually 
best to do very little ; rest, mild drinks, and a gentle pur- 
gative are enough to prescribe. Therefore, when called to 
see a patient whom I find complaining of some headache, 
general muscular weakness, alternate sensations of cold and 
heat quickly succeeding each other, loss of appetite, etc., I 
have good reason to suspect typhoid fever, and proceed at 
once to prescribe the proper means for aborting it, viz. : a 
tablespoonful of fever syrup every two hours for an adult, 
and in proportion for a child ; a warm mustard bath to the 
feet, and chloroform liniment or camphor and laudanum to 
the spine, and also to the stomach and bowels if there is any 
distress in that region, and direct quietness and the recum- 
bent position. When I call the next day, I expect to find 
my patient sitting up, and, if a female, attending to her 
amusements or domestic duties, and to be greeted with, 
" Why, Doctor, you've come too late ; I've got well ; I 
was more scared than hurt; I feel as well as common 
to-day, etc." 

But, as often occurs, the patient waits a day or two 
longer before applying for medical aid, and takes a dose of 
calomel or some other mercurial. I am now told that the 
physic "worked powerfully, and brought away more bile 
than you ever saw ;" but upon making closer inquiry, or, 
what is better, by seeing the dejections, I find that the bile 
is nothing more than yellow water, presenting the appear- 
ance of an egg stirred up in a gallon of very thin gruel. 
I also find, too, that the patient feels generally worse : his 
headache has increased ; more pain in the back ; skin hot- 
ter; tongue covered with fine white fur, and is broader 



TREATMENT OF TYPHOID. 123 

than- natural ; abdomen is more tumid, and slightly tender to 
pressure ; pulse more frequent ; heat persistent. I am now 
satisfied that I have a real case of typhoid fever before me, 
and put him upon the treatment that was suggested for yes- 
terday, with the addition of a poultice to the bowels. If 
called in still later, say a week from the first decided indis- 
position, I will find more heat of the skin ; greater restless- 
ness ; headache unabated ; confusion of ideas ; talks wildly 
when dozing ; tongue more coated in the middle, a little red 
at the edges and slightly contracted, and, on protruding it, 
I perceive a little quivering, as though its fibres were act- 
ing "one at a time." 

If the case is neglected still a day or two longer, the 
tongue will be decidedly pointed, be a deeper red at the 
edges, and will perhaps tremble with a palsied motion or 
look rigid, with its tip turned upward. I now have a 
case which will do to record in my note-book, "A case of 
typhoid fever of five days' standing." Well, I should com- 
mence the treatment now just as I would have done at 
first, so far as giving the syrup is concerned. It would be 
syrup every two hours, liniment to the spine, poultice to 
the bowels, cold applications to the head, and sponge the 
limbs with warm soap-suds. On my next visit I should 
expect to find but little change of symptoms, for when this 
fever gets five to eight days' start, it will not yield in a few 
hours ; it now seems to have the tenacity of life of the 
snapping-turtle, and, like it, will hold on to its grasp some 
time after its vitals are crushed. I should therefore feel 
contented to find my patient no worse : perhaps less head- 
ache ; not quite so restless, and bowels not so excitable, 
etc. A very gradual, hardly perceptible improvement may 
be expected until the third or fourth day of treatment, 
when I should expect to find general evidence of improve- 
ment; the pulse, for example, about 90; skin much cooler; 
headache gone; sleep undisturbed; tongue not so red and 
pointed ; but still no appetite, and no signs of increasing 
strength ; perhaps the patient feels weaker, and will not 
believe that he is really any better. But I tell him he will 
be better to-morrow, and suggest some light diet, which I 



124 on fever: 

direct to be taken with the punctuality of medicine. • On 
the next day I expect to find a decided improvement in his 
appearance : his countenance looking bright ; his skin filled 
out, and looking lively and glossy; his eye brighter; his 
tongue having lost some of its redness and assuming its 
natural shape, but yet trembling. He now inquires what 
he may be allowed to eat, and likely suggests some article 
that strikes his fancy. If the tone of the bowels has not 
been injured before I have taken charge of the case, and it 
has not been of more than five days' continuance, I usually 
permit the patient to have a little of any diet he may fancy, 
even fried chicken or broiled bacon. But if purgatives 
have been injudiciously used, or the fever is in its second 
week when I first see it, I know that the bowels have been 
so injured that the utmost care will be required during con- 
valescence. 

My usual form of administering the syrup is, to give it 
in twice its volume of water or milk. It should always be 
diluted with milk for infants and small children ; and this 
is generally the best vehicle for giving it in fevers for all 
ages, the milk furnishing the means of sustaining the sys- 
tem, and the syrup securing its proper digestion and assimi- 
lation, thus preventing a loss of tone in the stomach or 
much prostration of general strength. But sometimes the 
syrup, given in any way, becomes repulsive to the stomach, 
which renders it imperative to devise some other form in 
which to administer the remedies. The following pill con- 
stitutes a good substitute : Recipe — Pulverized rhubarb, 
30 grains ; piperin, valerianated zinc, and extract of liquor- 
ice, each 10 grains ; oil of sassafras, 20 drops ; make 30 
pills, each of which will be about equal to a tablespoonful 
of the syrup, and may be given at the same intervals. I 
often find it convenient and politic to substitute the pills 
for the syrup, even when the latter is taken kindly, so as 
to prevent the patient from becoming tired of taking the 
same thing. It is generally best to give the pills in the 
night, and the syrup during the day. When the medicine 
is given in the form of pills exclusively, I have thought its 
effect in breaking up the febrile movement was not quite so 



TREATMENT OF TYPHOID. 125 

potent as when given, at least part of the time, in the form 
of syrup. I never have a patient roused out of a quiet 
sleep to take medicine. As soon as convalescence is fairly 
set up, I make the intervals longer between the times of giv- 
ing the medicine, making them three, four, and six hours, 
and finally ordering only a teaspoonful to be taken directly 
after eating each meal. 

When called to take charge of a patient in an advanced 
stage of the disease, after active inflammation has been set 
up, I meet this complication with additional treatment. If 
of the brain, I apply cold applications to the head, and a 
blister to the back of the neck, letting it extend some way 
down between the shoulders. If of the bowels, I first 
poultice, or pour a stream of warm water for an hour or 
two upon the exposed surface, and then poultice ; and if 
these means fail, I then apply a blister : I prefer a large 
one ; the irritation produced by a small blister is usually 
transferred to the greater one beneath, making the disease 
worse by adding to it. 

I pay no attention to the secretions of the liver, know- 
ing that, when the remedies have set up general capillary 
action, those of the liver will also participate in the reac- 
tion, and healthy bile will be secreted ; and also knowing 
that a forced effort of the liver, under the goadings of mer- 
curials, will in no way aid me in breaking up the febrile 
movement. I therefore only watch for the return of 
healthy biliary secretions with the same solicitude that I 
do other secretions ; viewing all of them not as a cause, but 
a consequence of commencing convalescence. If called in 
at an advanced period of typhoid fever, I can make no 
promise as to the time which the disease may then run ; 
but if there are no serious inflammatory complications, I 
usually, even then, break up the febrile movement in four 
or five days, but convalescence is tedious. 

I will now further illustrate my mode of managing typhoid 
fever, by detailing a number of cases treated by myself and 
others : 

Case 1. August 30th, 1853. — A boy employed by Capt. 
William B. Walton. Has had constant fever thirty hours. 



126 on fever: 

Great sense of weariness, much distress of the head, ten- 
derness of the epigastrium, pulse full and throbbing, tongue 
covered with very short white fur and slightly red at the 
tip. Prescription : Bathe the abdomen and spine with 
liniment, and give a tablespoonful of syrup every two 
hours. 

31st. — Had a slight chill last night and some fever, but 
no headache or other distress. Added five gr. quinine with 
four ounces syrup, and ordered a tablespoonful every four 
hours. 

September 1st. — Appears clear of disease. Ordered the 
medicine to be given three times a day for a few days. 

Case 2. September 1st, 1853. — John Stone, clerk at 
the Verandah. Has for several days suffered from a feel- 
ing of prostration, and a sense of heat and chilliness alter- 
nately ; during the last night, sweat profusely and had 
copious discharges of yellow water from the bowels ; abdo- 
men tumid and sore, tongue furred and rather dry, sub- 
stance of it rather dark-red, inclined to doze, and dreams 
half waking, pulse quite compressible, and variable, con- 
stant alternations of cold and hot sensation. Prescription : 
liniment to the spine and abdomen, tablespoonful of syrup 
every two hours. 

Evening. — Pulse tolerably full and regular, skin warm 
and moist, abdomen less tense and tender. Continued 
treatment. 

2d. — Same general improvement. Continued treatment. 

3d. — Slowly improving; has had no passage from the 
bowels. Ordered two blue-mass pills, and continued syrup. 

4th. — Found general improvement, consistent discharges, 
tongue cleaning, some appetite. Syrup every four hours. 

5th. — Left his room and rode out. 

Case 3. September 18th, 1854. — Mr. Jackson, College 
street, boat-hand. Symptoms : dull, heavy headache, with 
disposition to sleep, mutters when dozing, skin hot on the 
body, extremities rather cool, abdomen tumid and tender to 
pressure, considerable diarrhoea, tongue furred in the mid- 
dle, but clean and red at the edges, and becomes pointed 
and trembles on protruding it. 



TKEATMENT OF TYPHOID. 127 

Treatment. — A poultice of corn-meal and mustard to the 
abdomen, liniment to the spine, and a tablespoonful of syrup 
every two hours. 

19th. — Does not mutter so much in his sleep, bowels 
quiet, abdomen less tense and tender. Continued treatment. 

20th. — General improvement. Discontinued treatment, 
except syrup every two hours. 

Case 4. January 1st, 1855. — Son of Mrs. Taylor, Cedar 
street, aged about twelve, small of his age and slightly 
formed, but usually enjoyed good health and was sprightly. 
His mother informed me that for about a week before I was 
called in, he had appeared unusually dull, and was inclined 
to sit about the house, and when directed to go on errands, 
went reluctantly; finally complained unusually of cold 
whenever he left the fire ; lost his appetite, had headache, 
and soreness of the abdomen ; diarrhoea at last set in, which 
for the last two days had been very severe, producing great 
prostration. I found him laboring under considerable head- 
ache, intolerance of light, abdomen tense, tumid, and tender 
to pressure, considerable heat of the head and trunk, but 
extremities cool, tongue thickly coated with short white fur 
in the middle, but clean and shining red at the edges ; in 
thrusting it out it became extremely narrow and pointed, 
and trembled exceedingly. 

Treatment. — A poultice of corn-meal and mustard to the 
abdomen, hot bricks to the feet, liniment to the spine, and a 
tablespoonful of syrup every two hours. 

2d. — Greneral improvement; headache less distressing, 
diarrhoea checked, stools consistent, abdomen less tense and 
tender, tongue not quite so deep-red at the edges nor so 
pointed, but still trembles. Continued treatment, giving the 
syrup every three hours. 

3d. — Is still improving. Discontinued all treatment, ex- 
cept the syrup every four hours. 

4th. — Is clear of all evidence of disease, appetite returned. 
Directed the syrup three times a day for a few days, and 
dismissed the case. 

Case 5. By Isaac N. Croom, M. D., Henderson county, 

Tenn. 

9 



128 on fever: 

"Mr. C.j aged 16, was taken December 29th, 1858j with 
a chill ; fever continued, and I was called in December 31st. 
Found him restless ; pain in the head, back, and limbs ; skin 
hot and dry ; tongue furred in the middle and dry, red tip 
and edges, pointed and tremulous ; bowels tender, and a 
disposition to diarrhoea ; pulse 120. 

"January 1st. — Symptoms about the same. 

"2d. — Pulse 100; slept well; said he was nearly easy, 
but no appetite. 

"3d. — Patient decidedly convalescent, and recovered 
speedily. 

" The above case was treated upon your plan for typhoid 
fever entirely. A number of other cases could be given, 
which have been managed with equal success." 

Case 6. By J. E. Fulton, M. D., Big Oak ? Miss. 

"On the 20th September, 1858, I was called to see Mrs. 
W.j aged about 30, good constitution, former health very 
good. I found her laboring under slight fever ; some head- 
ache; pain in the back; slight tympanites [swelling from 
wind] of the bowels ; some soreness in the right iliac region ; 
slight diarrhoea ; tongue long and peaked and very tremu- 
lous, edges red, and black scurf down the middle. She 
informed me that she had been ill-disposed for four or five 
days, but thought it unnecessary to send for a doctor, and, 
said she, i I don't think I am much sick now.' Being satis- 
fied of what was the matter, according to your directions, 
I put her on the comp. syrup of valerian, [fever syrup,] a 
tablespoonful every four hours ; and on the 21st visited her 
again : but little improvement, probably not so much pain 
in the back. On the 22d I found her with less headache, 
and diarrhoea diminished; continued the syrup. On the 
23d, considerable improvement of all the symptoms ; and 
on the 24th, I found her sitting up in the bed eating; and 
on the 25th, I found her sitting on a chair rocking the babe. 
I dismissed the case, but ordered the syrup to be continued 
for a few clays. The recovery was rapid and complete in a 
few days. 

" Such has been the termination of all such cases since 1 
came in possession of your most excellent book." 



TREATMENT OF TYPHOID. 129 

Case 7. By D. C. A. Moses, M.D., Eldridge, Ala. 

" I was called to see W. G-. W. K, on the 20th of April, 
1857 ; and npon inquiry, learned that for the week previous 
he had been complaining of loss of appetite ; general lassi- 
tude ; inability to confine his mind to his business, (which 
was that of merchant;) dull pain in the head; general 
feeling of soreness in the muscles ; chilly sensations alter- 
nating with heat ; occasionally cold clammy sweat, morbid 
vigilance, etc.; and at the time of visit found all these 
symptoms aggravated, with considerable febrile excitement ; 
pulse about 110; considerable thirst; tongue dry and 
pointed, tremulous upon protrusion; bowels slightly tym- 
panitic, and tendency to diarrhoea ; and during sleep con- 
stant muttering. Diagnosed, typhoid fever eight days' 
standing. 

" Commenced treatment by sponging body (which was 
dry and hot) with warm whiskey, afterwards applied ano- 
dyne liniment to the spine and abdomen ; tablespoonful of 
comp. syrup valerian every two hours ; warm poultice to 
bowels, etc.; and without giving you the treatment for 
each day, which was nearly the same, suffice it to say, in 
six days he was convalescent. From imprudence, on the 
eighth day after convalescence, (having resumed his busi- 
ness and exposed himself for several hours in a cool draught 
of wind,) he relapsed, and when called to see him, I found 
him in the following condition : Perfect prostration, constant 
muttering, almost impossible to arouse him sufficiently to 
give medicine, hemorrhage from bowels, subsultus tendinum, 
impossible to protrude the tongue, bowels tympanitic, pick- 
ing at imaginary objects, etc. But with the comp. syrup 
valerian and some auxiliaries, he was again convalescent on 
the ninth day, and has enjoyed uninterrupted health from 
that time to the present." 

Case 8. By W. J. Miller, M.D., Gas Factory, Tenn. 

" July 9th I was called to see James W., aged 17, sound 
constitution, had never had any serious sickness ; had been 
complaining, for a week previous to my visit, of soreness 
of the flesh, aching of his bones ; chilly sensations, hot and 
cold flashes ; when he would cover up, would become too 



130 on fever: 

hot, and when removed, he would soon feel chilly ; tongue 
coated with white fur. His father had given him a dose of 
castor oil, which had acted freely; considerable fever; 
pulse 100. I prescribed six grains blue-mass, neutral mix- 
ture, and sponging the body. On the 10th I found all the 
symptoms increased, drowsiness and headache added to the 
above symptoms. I thought I had now a case of typhoid 
fever, and commenced your plan of treatment at once. It 
is useless to describe the treatment, as it was just as you 
direct. On the 11th, not much alteration any way. The 
12th, the pulse had come down 12 beats, with some modifi- 
cation of sldn and tongue. 13th, considerably better. 14th, 
so much better that I did not visit him any more. His 
fever had all gone, tongue about clean, headache gone, and 
soreness gone." 

Case 9. Dr. T. Gr. Underwood, of Orange, Ga., writes 
that during the fall of 1858 he had an opportunity of treat- 
ing many cases of typhoid fever, as that disease was 
epidemic in that region of country. He gives the symp- 
toms as follows : 

" Want of appetite ; giddiness and sometimes nausea ; 
countenance dejected, dull heavy sensation in the head, and 
a general feeling of weariness ; general debility ; no inclina- 
tion to mental or corporeal action ; tongue coated with a 
white fur. These are the premonitory symptoms ; after 
which slight chills in the majority of cases, alternating with 
heat of the body ; entire disgust for any kind of food ; 
pulse quick and small ; mind confused ; dull, heavy pain in 
the head ; general mental and physical depression ; pain in 
the back and limbs. These symptoms would last for a 
short time ; after which the febrile heat would increase ; 
the face become flushed ; the pulse rise in strength ; the 
skin become dry and the lips parched ; great thirst for cool 
drinks ; tongue coated now with a brown fur ; pain in the 
head, back, and limbs ; increased tension and tenderness in 
the hypochondria ; the brain more disturbed ; hearing 
obtuse, and more or less delirium. Other symptoms were 
occasionally present. 

"All such cases treated by other physicians, not in pos- 



TREATMENT OF TYPHOID. 131 

session of your plan, ran the usual course. I treated mine 
upon the plan laid down in your book, and the average 
time of treatment before convalescence was from six to ten 
days ; owing, though, a good deal to what stage of the dis- 
ease I was called in; if in the first stage six days, and if 
not, ten days. 

"There was but one death, and that patient relapsed 
from eating pork and turnips after she was able to walk 
about the room." 

The following letter, though not from a physician, con- 
tains so much good sense that I am induced to give it 
entire : 

Sunflower Landing, Coahoma County, Miss., 
March 12, 1859. 

R. Thompson, M. D. : 

Dear Sir : — Not being a physician, but only a planter, it 
did not seem important that I should give my experience with 
your mode of treating fever ; but courtesy to you, and also 
a wish to add my testimony as to its value, induce me to 
address you. 

I have used your plan constantly since the early part of 
1857, and in no case without beneficial results. Besides 
its use in pneumonia and typhoid fever as prescribed in 
your book, I have used your fever syrup advantageously as 
a general stimulant for feeble persons ; and in this our 
damp and miasmatic climate, I am satisfied it is very valua- 
ble in such cases, affording a resisting power to the consti- 
tution. In a few instances (that of my wife amongst others) 
the recurrence of chills has been prevented by it. But I 
generally first break the chill with quinine, and then give 
the syrup to insure convalescence. 

In our climate the constitution seems to have very little 
reacting power, even after disease has entirely disappeared; 
in other words, we get well slowly ; and this depressing 
tendency of the atmosphere to keep us down when once it 
gets us down, is to be overcome by stimulation. No other 
stimulant appears to be equal to the fever syrup for this 
purpose. The syrup has been used on the plantation of 
my sister-in-law, also in this vicinity, by the overseer, 



132 ON FEVER : 

whether intelligently or not I am not able to say; still, 
neither there nor on my own place has death ensued in a 
single case in which it has been used ; in other words, we 
have not lost a single case of pneumonia or typhoid fever 
since I became acquainted with your plan of treatment, and 
we have had to contend with some severe ones. It is pro- 
per to say that I have also used quinine, ipecac, Dover's 
powder, and blue-mass, very moderately in the earlier 
stages, and also blistered ; but have invariably employed 
your syrup in a manner fully up to your directions, relying 
chiefly upon it. 

One of my neighbors thinks I saved the life of a mem- 
ber of his family, a month or two since, by sending him a 
bottle of the syrup with directions. 

I ought to add that I have given it in cases of ordinary 
bilious fever, remittent and intermittent, but could not see 
any marked advantage until after the disease had been 
broken up by other usual remedies ; then, as a stimulant to 
aid convalescence, it is of much value. 
Very respectfully yours, 

H. C. Chambers. 

J. D. Steel, M. D., of Charleston, Miss., informs me that 
he has treated about seventy cases of typhoid fever upon 
the plan laid down in this work, without a death, and that 
convalescence was set up in from three to five days. Many 
other physicians have furnished evidence that typhoid fever 
can be aborted by my plan of treatment ; only one states 
that he has failed, and I am forced to the conclusion that 
the materials he used could not have been genuine. 

It is well known that there are two kinds of sassafras, 
the red and the white ; now the oil obtained from the white 
is nearly inert, it has little pungency, and will not destroy 
insects. It may be known from the red by having a whiter 
color. 

One physician inquires of me if the syrup is contra-indi- 
cated in gastritis connected with fever. I have already 
said that it is, but in mere excitement of the stomach it 
may be freely given, as it serves to allay it; and much 



TREATMENT OF TYPHOID. 133 

experience by myself and others has proven that it may be 
given not only with impunity, but with signal advantage, 
when there is inflammation either in the small or large in- 
testines. In inflammation of the stomach it makes too 
strong an impression, and must be suspended. For such 
cases, besides poultices and fomentations, I give the fol- 
lowing : 

Emulsion of Gum- Arabic, 4 oz. 
Sulphate of Morphia, 4 grains. 
Spirits of Turpentine, 1 drachm. 
Comp. Spirits of Lavender, 2 drachms. 
Mix. 

Give a teaspoonful every two hours. A free application of 
the chloroform liniment should also be made to the spine 
and stomach. As soon as the stomach Js relieved, the syrup 
should be given as before. 

A number of practitioners have complained of the great 
pungency of the syrup, which renders it difficult to take. 
This must be owing to some fault in its preparation. No 
medicine is taken with less trouble by my patients ; in fact, 
it is often spoken of as being peculiarly grateful, and if the 
directions already given (of rubbing the sassafras, piperin, 
and sup. carb. of soda first in a mortar, and then adding the 
syrup of rhubarb, again rubbing it, and lastly adding the 
tine, val.) are observed, it will never be unpleasantly pun- 
gent. Druggists will not attend to these particulars unless 
especially charged upon the subject; but if the syrup is 
still too pungent, order it taken in sweet milk or emulsion 
of slippery-elm or gum-arabic. 

I will now give a condensed view of the treatment recom- 
mended by standard authors in this disease ; but it will be 
perceived that they agree in very few points, except in the 
belief that no remedy will shorten the disease. 

Dr. Jackson commences with an emetic of tartarizeel 
antimony, and follows it with an active cathartic. If this 
does not afford decided relief, he then uses venesection, 
letting the blood flow until an impression is made ; then 
gives tartar emetic in broken doses every two hours until 
decided nausea is produced, restraining its action on the 
bowels when necessary with opium. Formerly gave calo- 



134 on fever: 

mel in frequently-repeated small doses, so as to produce 
salivation, but finally abandoned the measure as useless if 
riot injurious. 

Dr. Nathan Smith has never seen any remedy shorten 
the duration of the disease ; in mild cases gives no medicine, 
but keeps the patient quiet ; gives mild drinks and nourish- 
ment. In severer cases uses such means as will mitigate 
the most prominent symptoms ; looks upon emetic tartar as 
"an inappropriate and unsafe remedy;" has known it con- 
vert a mild case into a severe one. 

Chomal, of Paris, follows the expectant plan, giving only 
mild drinks ; sponging with cold water ; fomentations, 
mucilaginous injections, etc. ; and in the latter stage gives 
tonics and stimulants ; bleeds if the symptoms indicate it. 

Loves pursues pretty much the same plan, but resorts to 
bleeding oftener. He says that "by the judicious use of the 
three principal means — bleeding, sweating, and tonics — the 
disease may be shortened a little — a day or two at least," 
and "hopes that a more successful treatment of this disease 
will yet be discovered." 

Bouillaud bleeds freely and repeatedly, and cups and 
leeches in the intervals ; does nothing else. 

De Laroque begins with an emetic, and then gives daily 
brisk purgatives throughout the entire course of the disease. 

Bartlett recommends the eclectic plan in a mild way, 
merely combating symptoms and taking care of the strength 
as much as possible, to enable the patient to bear up under 
the tedious course usually run by this disease. 

Wood commences with a mild purgative ; then bleeds, if 
arterial action is high ; gives refrigerants to moderate pain ; 
and in the second stage gives mercury and turpentine to 
combat inflammation. 

BILIOUS OR MIASMATIC FEVER. 

This disease presents a wide diversity of grades and 
symptoms, as it is seen in different latitudes, or in different 
individuals in the same region. 

The leading symptoms as clearly indicate primary disturb- 
ance in the cerebro-spinal centres, [brain and spinal mar- 



BILIOUS OR MIASMATIC FEVER. 135 

row, J as those of typhoid fever do a morbid condition of 
the ganglionic system, [great sympathetic nerve.] But as 
the latter system must become considerably disturbed be- 
fore capillary inaction can be produced, which, we have 
seen, is an essential part of every case of fever ; and as we 
see the secretions all more or less depraved, which also are 
under the control of the ganglionic nerves ; we need not be 
surprised that in many cases it is difficult to decide, espe- 
cially in the early stages, whether a case be typhoid or 
bilious. In elevated countries and in vigorous constitutions, 
if this disease occurs at all, it is usually characterized by a 
high grade of action, simulating inflammatory fever ; where- 
as, in the far South, and in the West, in recently reclaimed 
alluvial districts, vital energy is often so completely ex- 
hausted by a continued action of the cause of this disease, 
that very slight reaction follows the stage of depression, 
and in some instances there is no reaction at all, but the 
patient dies in the first stage. In other cases the reaction 
is considerable, but is followed by very slight remissions, 
merely a lessening of the most urgent symptoms in the 
morning, as in continued fever ; then, again, we see well- 
marked remissions, and in others complete intermissions, so 
perfect, that one unused to the disease would never expect 
a recurrence. 

Now it has been a matter of inquiry for many thousand 
years, what is the nature of the morbific agent which pro- 
duces this disease, and what are the circumstances necessary 
for its elaboration. At one time the medical mind had 
decided that it originates in the decomposition of vegetable 
matter, but this idea is now generally abandoned ; and it 
has been equally authoritatively decided, that the only 
circumstance necessary for its production is high tempera- 
ture, acting upon a soil which has been saturated with 
moisture. But however produced, or whether organized or 
unorganized, it is certainly a narcotic poison : the symptoms 
which precede an attack indicate this; as giddiness of the 
head, erratic pains, muscular weakness, pallor, and a dirty 
hue of the surface — -just what we often see following an 
intemperate use of tobacco, opium, and other narcotics — 



136 ON FEVER : 

and in very grave attacks, produced by sudden exposure to 
the poison in a highly concentrated form, the symptoms are 
precisely those of intense narcotism, occasionally causing 
death without even the nervous reaction constituting a 
chill. 

Now this inquiry into the nature of the poison producing 
bilious fever is not merely interesting, but is of the first 
importance to a correct understanding of my plan of curing 
it. For a long time the cinchona [Peruvian bark] and its 
preparations have been chiefly relied on in the treatment of 
intermittent fever, but all agree that, notwithstanding the 
disease is very uniformly arrested by the use of quinine, 
yet it is proverbially prone to return, often making it 
necessary to cure it many times before it will finally stay 
away. Now this is accounted for by the fact that quinine 
cures intermittents by acting as a nervous stimulant, pro- 
ducing a state of nervous power incompatible with that 
attending a chill ; but the effect soon subsiding, it is not 
wonderful that the disease returns. Now the oil of sassafras 
evidently neutralizes this narcotic poison ; and hence, when 
it is combined with quinine, the disease very rarely returns ; 
but more of this presently. 

I will now take up a case of bilious fever, and run it 
through its course, in order to illustrate my mode of 
management. 

Suppose, for example, I am called to see a case present- 
ing all the common symptoms of the forming stage of fever, 
and almost a counterpart of the one which we have con- 
sidered, which turned out to be typhoid fever, but still 1 
am not warranted in deciding that this will prove to be one ; 
perhaps there have been other attacks lately in the family, 
or the immediate vicinity, which have shown themselves in 
their progress to be malarious, and I reasonably presume 
that this is of the same kind. But if I have determined to 
abort it, any speculations as to whether it is typhoid or 
miasmatic are uncalled for, as that point will never be 
ascertained ; for putting the patient under the same treat- 
ment proposed in the forming stage of typhoid fever, will 
so effectually break up the diseased action, that no trace 



BILIOUS OR MIASMATIC FEVER. 137 

will be left which would indicate what way the disease 
would have run. 

But suppose I try a dose of calomel given in the evening, 
and visit the patient next morning, and find him much 
improved — the headache gone, the skin naturally moist, 
consistent bilious discharges, etc., etc. — I settle the case in 
my mind at once, that I had treated bilious fever in its 
forming stage. But have I aborted it ? Perhaps not, the 
favorable appearances notwithstanding; and if I do not 
guard against it, by the time I have made my round of 
calls and returned to my office, I will probably find a press- 
ing message to repair in haste to see my patient, as he is 
much worse. Well, I judge at once that he has had a chill ; 
and so I find on my arrival. He is now in the stage of 
reaction, and his headache violent; heat of the surface 
pungent ; thirst great ; stomach irritable ; pulse full and 
throbbing, etc., etc. JSTow what are the indications ? Clearly, 
to quiet the nervous excitement, and open the capillaries 
so as to admit the blood to flow on freely from the arteries, 
and thereby relieve the excitement of the heart ; and I will 
do this by giving a large dose at once — two or three table- 
spoonfuls of comp. syrup valerian in a glass of cold water — 
and at the same time bathe the head, neck, breast, and arms 
with cold water ; in less than half an hour I will have my 
patient quite comfortable. I then leave him the following 
prescription: Sul. quinine, piperin, blue-mass, each 10 gr. ; 
oil sassafras, 5 drops; make 10 pills; give one every two 
hours until they are all taken ; then give a tablespoonful of 
the fever syrup, at the same interval, in half a glass of cold 
water, and direct some additional purgative to be taken 
after the time of the chill has passed, provided the bowels are 
not pretty freely moved without. I usually prefer Epsom 
salts. But I very often, yes, generally, leave out the mer- 
curial entirely, and treat the case with the syrup alone, 
except a single five grain dose of quinine given soon after 
the hot stage begins to abate. The liver will commonly 
act very well without any assistance, except the general 
capillary excitement produced by the syrup. Another 



138 on fever: 

formula often depended on is comp. syr. valerian, 2 oz., 
sul. quinine, 10 grains ; give a dessert-spoonful every three 
hours. If the chill should be prolonged, and the reaction 
imperfect, showing that the fever is of the type known as 
congestive, I still give nothing but the syrup, but increase 
the dose largely ; have given two or three ounces at a time, 
and repeated it in an hour. This, with warmth to the 
extremities, and the " half-pack," [a cold wet sheet folded 
and laid over the body, and covered with a dry one,] with 
a free application of some stimulating liniment to the spine, 
will generally soon bring about a fine reaction. I then 
treat it as a common case of chills, except that I think it 
safer to increase the quantity of quinine. To those who 
have been in the habit of resorting to active depletion and 
free evacuations, in order to subdue the over-action in high 
grades of bilious fever, the idea of bringing down the excite- 
ment by the use of piperin, oil of sassafras, etc., will 
appear quite unphilosophical. But if they will recollect 
that the condition of the system in the lowest grades is pre- 
cisely the same which exists in the highest, and when they 
recollect what that condition is, they will cease to be 
astonished that the same capillary stimulant will meet both 
cases. 

I have had many of the high grades of bilious fever 
under my management within the last few years, which I 
formerly thought called for the use of the lancet, tartar 
emetic, etc., but which have yielded kindly to my present 
mode of practice, and left the strength of the patient but 
very little impaired, so that convalescence was rapid. But 
still if I were called to a case in which active inflammation 
had been set up in some vital organ, I should certainly 
bleed ; but my experience leads me to believe that in cases 
treated upon my present plan, no inflammatory complica- 
tions will probably ever arise ; they have not in my prac- 
tice. 

Now, if there be no distinct remission, I make one by 
sponging the body with cold or tepid water, or applying the 
wet-sheet or the half-pack of the hydropathists, and renewed 



BILIOUS OR MIASMATIC FEVER. 139 

as occasion requires. At the same time I order the fol- 
lowing : 

R— Comp. Syr. Val., 2 oz. 
Dov. Powder, 10 grains. 
Mix. 
Dose — a dessert-spoonful every two hours. 

I will further illustrate the treatment of bilious fever, by 
giving observations extracted from letters received from 
intelligent physicians in different States. 

J. W. Steel, of Charleston, Miss., says : " The year 1858 
will be remembered as the most sickly year within the 
recollection of the oldest inhabitant in this country. I pre- 
scribed for fully seven hundred cases of bilious fever, and 
as I made your book my guide, I lost no case, and had no 
protracted case. I very seldom prescribed any thing but 
the syrup, as it generally fulfilled every indication." 

Dr. Steel says nothing about adding quinine to the syrup. 

Dr. D. C. A. Moses, Eldridge, Ala., says : " The prevailing 
fever with us is remittent, of a low adynamic type. I have 
attended within the last year some three or four hundred 
cases, and have never failed to arrest or abort it in from 
twelve to thirty-six hours. I follow your book with hardly 
any deviations." 

Dr. Moses is also silent on the use of quinine as an 
adjunct. 

Case by A. D. Cutler, M.D., of Dresden, Tenn. : 

" I was called to a gentleman taken with a chill which 
had lasted twenty-four hours before I saw him — had a con- 
gestive chill, I would say. Gave him calomel in twenty- 
grain doses, until four doses were given, which procured 
several copious green evacuations the next day. At my 
first visit I had none of the syrup with me. At my second 
visit, as the calomel had acted freely without apparent 
benefit, I resolved to try the syrup. He was still rest- 
less, with pains in the head and abdomen, sick stomach, 
tongue white, pulse one hundred and forty. Gave nothing 
but syrup, one tablespoonful every two hours in half a 
tumbler of cold water. Four ounces completed the cure in 
five days. It acted like a charm." 

As bilious fever in some of its forms is emphatically the 



140 ON FEVERS: 

disease of the South and West, causing perhaps more than 
half of all the sickness suffered, I think it best to dwell a 
little longer upon the subject. True, the general directions 
already given, if faithfully followed, will nearly always 
succeed, but the means recommended may not always be at 
hand, or, from some cause, may not agree with the patient, 
or, in case of relapse, may not prove as effectual as usual, 
owing to the system having become used to them by fre- 
quent repetition : most medicines lose their power over the 
system if long continued. I will therefore suggest other 
means that may be used with success ; and first, of remit- 
tent fever, or, as it is commonly known by the people, bilious 
fever. For very many years before I matured the particu- 
lar plan of treatment which I now rely on, I managed this 
disease very successfully with quite simple means — means 
which acted upon the same principle which those I now use 
do, though their manner of acting was not then so well 
understood ; and any sensible person, who has carefully 
studied what I have said upon the nature of fever, and the 
manner in which remedies must act in order to cure it, can 
always find some means, though he be in the midst of a 
forest, far from human habitation, that will answer the pur- 
pose pretty well. For though I think there will hardly 
ever be discovered any remedies which will act with more 
certainty than those already given, yet I by no means look 
upon them as the only means that will do the same thing ; 
and the fact that the same result can be brought about by 
the use of different remedies, forms a very good reason why 
the reader should strive to impress his mind with the great 
principles which have been dwelt upon in the preceding 
pages ; he will then never be at a loss to do something to 
advantage, though the best means may not at the time be 
within his reach. 

In the early years of my practice, I saAV that the plan 
of treatment then relied on by physicians for the cure of 
fever was not a good one, and I tried to find a better. I 
saw that the course of bleeding, .vomiting, active purging, 
salivating, and blistering, which the patient usually had to 
undergo, often caused the disease to terminate in death 



BILIOUS OR MIASMATIC FEVER. 141 

sooner than it would have done if let alone to run its own 
course ; and that, if the patient did recover, it was often 
with a shattered constitution. Now, as I thought that to do 
nothing would be better than doing harm, I early abandoned 
this destructive mode of practice, and resorted to means 
which, should they fail to break the disease, would at least 
not kill my patient. I thought if I could find means that 
would produce the various effects which we all aimed at, 
and would not of themselves produce debility, I would be 
able to assist nature in sustaining the force of the disease, 
and aid in throwing it off. My knowledge of the virtues 
of our indigenous plants was now of service to me ; this 
knowledge had not been originally acquired from books, but 
from observation and experience. In my early boyhood, 
doctors were " few and far between," and our mothers from 
necessity turned doctors. The author very early manifested 
some capacity and showed an inclination to wait upon the 
sick, and was soon installed as nurse in the family, and 
frequently acted as such among his near neighbors, always 
following the instructions of his mother, in whose skill he 
had great confidence — who, by the way, was a woman of 
much good natural sense, great pfudence, and untiring 
energy ; was, in short, in the proper sense of the term, a 
" strong-minded woman," and yet enjoys a green old age of 
over four-score and ten. 

In this way the author acquired a pretty good acquaint- 
ance with all the most useful domestic remedies, and it was 
now to this source that he turned in search of means by 
which he hoped to manage fever without causing exhaus- 
tion. 

Among our indigenous medicinal plants, the boneset (Eu- 
patorium Perfoliatum) was deservedly held in high repute ; 
I knew it would act as an emetic, when given in form of a 
strong infusion, and administered freely ; I also knew that 
it afterward usually produced active perspiration ; having 
also tonic properties, it left the system invigorated. So the 
next attack of fever I was called to treat I managed as 
follows : Finding a full pulse, throbbing carotids, great head- 
ache, etc., I thought I dare not omit bleeding, and perhaps 



142 on fever: 

it was best not to ; after abstracting twelve or fifteen ounces 
of blood, I gave half a pint of a very strong infusion of the 
boneset, and repeated in fifteen minutes ; the second draught 
was soon followed with free emesis, [vomiting,] throwing off 
considerable bile ; a weaker infusion was now given, until I 
supposed all the bile then in the stomach was discharged ; 
near a tablespoonful of Bateman's drops was now adminis- 
tered, for the purpose of quieting the stomach, and exciting 
perspiration. I also gave ten grains of calomel to carry off 
the bile from the bowels, and be ready to act by the time 
the sweating process should be over. Perspiration was 
kept up pretty actively several hours, by frequent draughts 
of infusion of wild sage, with a grain of ipecac, to the pint. 

After getting my patient fairly under the sweating pro- 
cess, and directing a tablespoonful of epsom salts adminis- 
tered in the morning to work off the calomel, I left quite 
pleaded with the plan thus far. On my visit next day I 
found my patient much better, but there was still consider- 
able fever ; but the headache and restlessness were much 
less. I directed a moderately strong infusion of the bone- 
set, with two grains of ipecac, to the pint, a tablespoonful 
every hour until the patient sweat or vomited, and then to 
be followed by the Bateman's drops, calomel, and wild sage 
tea, as on the day before. On my third visit I found my 
patient quite clear of any manifestations of disease ; there 
was very little prostration, appetite returning; directed a 
bottle to be half filled with equal quantities of dogwood, 
wild-cherry, and yellow poplar bark, and then filled with 
rye whiskey, (it being made in the neighborhood, it could 
be always obtained genuine,) the patient to take a wine- 
glassful three times a day, to prevent relapse. This I 
looked upon as a great achievement — a case cured in forty- 
eight hours, which under my former treatment would pro- 
bably have lasted two or three weeks at least ; and this 
without a sore mouth, and with a whole skin. 

My after experience was equally satisfactory. Some 
cases would linger a few days longer, and some required 
the aid of other means; but whatever was done, the main 
point was kept in view, not to exhaust the patient's ener- 



BILIOUS OR MIASMATIC FEVER. 143 

gies. Nothing was said about this new practice, and, there- 
fore, the author escaped the odium of an innovator, and the 
opposition of his professional brethren. About all that was 
said was, that "Thompson was very successful, and didn't 
give much strong' medicine." The author pursued this 
practice for about six years, when his health failed from 
excessive labor, so that he thought it advisable to seek a 
milder climate, and accordingly came to Tennessee. In the 
course of a few months his health so far improved as to 
warrant him again to commence practicing in a small way. 
Here he met with cases of the same grade of fever with 
which he had contended in Ohio ; but there was a much 
greater tendency to chills ; but as quinine had now been 
fully introduced, he found but little difficulty in the man- 
agement of that feature. 

But he was quite at a loss concerning his favorite 
remedy, the boneset ; it could not be found in the vicinity, 
and the dried article obtained at drug-stores proved to be 
quite inert ; so he was forced to seek a substitute, which 
he found in the vervine, a plant growing in almost every 
yard ; he found it a more stimulating emetic than the bone- 
set, but not quite so active ; therefore a few grains of 
ipecac, were added ; he also found in the scabish, a white- 
blossomed weed infesting small grain and clover fields, a 
most valuable sudorific. It is equally as powerful as the 
boneset, and much pleasanter, and less apt to nauseate. I 
now rarely bled, but still thought it essential to vomit, and 
after the vomiting, my habit was to give ten grains of calo- 
mel with three of Dover's powder, and then commence 
with the infusion of scabish, adding a teaspoonful of sp. 
nit. dulc. to each draught if there were much heat of the 
skin ; this was continued for several hours, and then fol- 
lowed with the infusion of wild sage, which I could always 
find. I also became acquainted with another exceedingly 
mild and pleasant sweating remedy — the queen of the 
meadow. This is a most noble-looking plant, growing often 
fifteen feet high, with a stem an inch and a half in diame- 
ter ; but it is rather a rare plant, being only found in rich 
bottoms untrodden by cattle ; but, as the stem was the part 
10 



144 on fever: 

I used, an inch of which being sufficient for a pint of boil- 
ing water, a single stalk would suffice for a year's practice. 
The tea made from this plant has hardly any taste, and 
when cold, is taken by patients freely during the highest 
fever, when any of the other remedies named would be 
contra-indicated, or too repulsive to be borne by the 
stomach. The tea of this plant, though destitute of taste, 
and apparently of medicinal virtues, yet often causes the 
fever to gradually abate, and a pleasant moisture to suc- 
ceed. Now all this time the author had no theory upon 
the subject, further than that fever is a depressing agent, 
and requires to be met by means which will sustain the 
vital energies. About this time, what is known as conges- 
tive fever was first seen by the author, the phenomena of 
which impressed him still more forcibly with the truth, that 
the cause of fever acts as a depressing agent. The same 
mode of treatment during the febrile stage, and large doses 
of quinine, after a remission had been obtained, enabled him 
to succeed very satisfactorily with this fever. But a few 
years later, he met with another form of fever, which 
brought him to a stand-still. He had heard, for a year or 
two, of a fever prevailing in a distant neighborhood, which 
the physicians could not manage ; it was said to go through 
whole families, and that very few recovered. One gentle- 
man, who had a wife and several grown children with him, 
besides quite a number of negroes, was in the course of a 
year left alone, except a few old servants. Finally, I was 
called to a case which at first showed nothing peculiar, 
except that though the symptoms appeared to be quite mild, 
and the patient complained but little, yet my usual reme- 
dies did no good, and the disease went on as though nothing 
had been done. I soon found that my treatment was doing 
positive harm — the sweating was exhaustive, and ended in 
prostrating diarrhoea. I abandoned sudorifics and resorted 
to blisters and calomel. At one time I thought I had suc- 
ceeded : the liver acted well, and there was some appetite. 
Soon another case occurred, a brother of the first ; I com- 
menced treating him with broken doses of calomel, and 
occasionally a teaspoonful of salts. Both went on, alter- 



BILIOUS OR MIASMATIC FEVER. 145 

nately giving good hope of success, and then arousing all 
my fears, until death put an end to the strife. 

Now it was clearly evident, upon a quiet retrospect of the 
cases, that I had done no good, and I believed had done 
harm. I therefore resolved, had I other cases, to do nothing, 
and wait for light. Some five or six other cases occurred 
in the family, which, upon the do-nothing system, all finally 
recovered. 

I said I did nothing, but that is not strictly true. I had 
the surface sponged with tepid soapsuds whenever it was 
too hot, and the bowels poulticed when they were painful, 
suppositories of opium used when there was diarrhoea, and 
broken doses of epsom salts when they were costive. I 
never improved upon this treatment until about ten years 
ago. During the long rides I frequently took between my 
home in Wilson and the Caney Fork country in Smith, 
where I was contending with epidemic dysentery, I care- 
fully reinvestigated the whole subject of fever, and sought 
to analyze it, so as to ascertain what was essential, and 
what secondary or incidental. By this process, I ascertained 
that there were but two things which were always present ; 
the absence of either was also the absence of fever ; these 
are, as my readers know, nervous disturbance and capillary 
debility. How all the other symptoms of fever grow out 
of these, and how my present mode of treatment was natu- 
rally suggested by this theory, have been fully explained in 
the preceding pages. 

This theory was often investigated, and the treatment 
proven by varied experience to be perfectly reliable, and 
of general application ; for as it attacks fever by removing 
the condition in which it consists, causing the febrile move- 
ment to subside, as water ceases to flow when the supply is 
cut off, I expected that typhoid fever ', taken at a stage before 
inflammatory complications were formed, would yield to its 
power just as other fevers, and so it did, every case yield- 
ing in a few days. Now it is very improbable that I should 
have been mistaken in diagnosing the cases — I, who for 
many years had, with great care, noted the first symptoms 
of the disease, in order to avoid doing mischief by improper 



146 on fever: 

medication, and thus had become able to detect the disease 
in its very earliest stage, with very rare exceptions. I was 
not mistaken. Others have not been mistaken, and have 
succeeded as fully as I claim to have done. A few others, 
it is true, have not been so successful, but these only form 
the exceptions to the rule, that typhoid fever treated upon the 
plan laid down in this booh, when taken in the incipient stage, 
or before inflammatory complications are set up, will yield in a 
few days, leaving the patient very little weakened or injured in 
any way. 

But to return to the subject of bilious remittent fever. 
I think what I have written upon this subject is amply 
sufficient to give any person of good sense a very accurate 
knowledge of my method of managing this disease ; but, as 
many of my readers may not have the leisure or inclination 
to study what has been said so as to remember each part in 
its proper connection, in order to assist such, I will now 
sum up the principal directions so that they can be all taken 
into view at a glance. When any of your family complain 
of the premonitory [threatening] symptoms of fever, viz. : 
sluggishness, some headache, loss of appetite, aching of the 
limbs, etc., you should not wait to ascertain whether the 
case will develop itself into bilious, typhoid, scarlet, or 
some other fever, or merely turn out to be a common cold, 
or pass off without any sickness following : people don't 
wait for the turning up of events when danger in other 
forms is threatening : if you find your fence broken, you 
mend it at once, and don't wait to see what kind of stock 
will break into your enclosure, or whether any kind will 
disturb you ; if your hay is out, and the sky looks lower- 
ing, you lose no time in waiting to see whether it will rain, 
or hail, or clear off, but you secure your hay ; the merchant, 
when passing events indicate a decline in prices, waits not 
to ascertain whether the fall will be little or great, or whether 
a reaction may not come in time to prevent any loss upon 
his stock on hand, but pushes it into market while it will 
bring a price that will insure him from loss ; so men act 
with regard to every threatened evil, except danger to the 
health of the body and the salvation of the soul : these 



BILIOUS OR MIASMATIC FEVER. 147 

they are too prone to risk. Well, when you have the 
symptoms mentioned as threatening an attack of some form 
of fever, let the diet be light, take a tablespoonful of fever 
syrup, or a cup or two of ginger tea, bathe the feet in warm 
water, as warm as it can be borne — it is better if mustard 
is added; go to bed early, and if the symptoms are not 
fully removed by morning, commence a regular course of 
treatment, as directed in a former part of this chapter, viz. : 
give the syrup in tablespoonful doses every two or three 
hours, apply the chloroform liniment freely to the whole 
length of the spine, and to every other part that is suffer- 
ing, but to the spine particularly, as there is the origin of 
the nerves which supply the greater part of the body with 
sensation, and if they are quieted at their origin, they will 
cease complaining in the parts in which they terminate. If 
the syrup is not at hand, give the boneset or vervine tea, 
with a race or two of ginger to prevent nausea. Give the 
tea in broken doses, so that, if the stomach is- not foul, it 
may act upon the skin without vomiting ; but if there be 
bile in the stomach, it will and ought to vomit. If it does, 
give freely of warm water until the stomach has emptied 
itself pretty well ; then give at least half a tablespoonful 
of paregoric or Bateman's drops to quiet the stomach. If 
neither of these is at hand, apply a mustard poultice to the 
pit of the stomach, and give no drink of any kind until the 
disposition to vomit has subsided ; then commence with 
some mild tea, such as wild sage, queen of the meadow, 
balm, etc. If the boneset or vervine tea should not produce 
much nausea, continue it until a free action on the surface 
is produced, then change it for one that is milder and 
pleasanter, and which can be drunk freely instead of water. 
If there is still headache and other bad feelings the next 
morning, give ten grains of blue-mass or six of calomel, and 
follow it in three or four hours with a dose of castor oil or 
epsom salts. After the purgative has operated two or three 
times, give Bateman's drops or paregoric, and follow it with 
some of the mild teas, as before. If there is any coldness 
of the feet, warmth should be applied to them ; also give 
two or three grains of quinine every four hours, until ten 



148 ON FEVER : 

or fifteen are taken ; cold water should be freely applied to 
the head if there is any unnatural heat; mush poultices, 
sprinkled with mustard, should be applied to any local part 
that may be suffering. As soon as the fever appears to be 
broken up, give bitters of dogwood, poplar, and wild cherry 
bark ; they may be used in spirits or in water. If there is 
any tendency to chills, add the bark of the root of the 
common willow. But a little foresight will enable every 
one, however remote from a druggist, to keep on hand my 
principal remedies, the fever syrup and the chloroform lini- 
ment ; and with them, if used as I have directed, the fever 
can be broken up quicker and with much less trouble. 

If the fever be intermittent — that is, if it goes entirely 
off and then returns again — whether there be any distinct 
chill or not, you should combine ten grains of quinine with 
four ounces of fever syrup, and give a dessert-spoonful, or 
half a tablespoonful, every three hours, commencing as soon 
as the fever begins to decline. If quinine cannot be 
obtained, make a strong tea of the willow bark and ginger, 
and give it as freely as the patient can take it ; and add a 
tablespoonful of Bateman's drops about an hour before the 
chill is expected. Mustard applied to the feet and to the 
stomach will very materially aid other means in keeping off 
a chill. The cold bath, or sponging the body with cold 
water, will be of great service in bracing the system, so as 
to hasten the recovery and prevent a relapse. The water 
should not be very cold, and, if the patient is very 
delicate or is much reduced, the sponging should be done 
before a brisk fire. Whatever remedies are used for break- 
ing up chills should be continued for some time after the 
patient appears to be well, as it is prone to return ; and 
after a few relapses it becomes exceedingly difficult to be 
kept off. If a teaspoonful of fever syrup is taken after 
each meal for a week or two, there will be very little danger 
of relapse. 

CONGESTIVE CHILLS. 

This form of bilious fever some years ago was quite 
prevalent in this country and exceedingly fatal, so much so 



CONGESTIVE CHILLS. 149 

as to cause the name to become one of terror to the people. 
Of late years we rarely hear of a case ; but as it still pre- 
vails in other parts of the South and great West, it becomes 
necessary to give it a particular notice. All fevers, and 
especially all chills, are congestive ; there is congestion in 
all ; that is, there is an unnatural accumulation of blood in 
the great veins ; but in the variety we are considering, this 
fulness or stagnation of the blood in the venous system is 
much greater than in other fevers, and hence it has received 
the name of congestive, to distinguish it from varieties in 
which this condition is less observable. 

The malaria, or poison which causes bilious fever, we 
have said, acts as a narcotic poison and produces nervous 
prostration; and, consequently, a loss of tone and vital 
energy in every part of the system, but especially of the 
heart and capillary vessels. Now the heart, being greatly 
weakened, acts feebly in pushing on the current of blood ; 
and the capillaries, being also weakened, do not pass it on, 
but become dilated and engorged with blood, so as to give 
to the surface a dusky or leaden hue. Now when the heart 
is vigorous and propels the blood with force, as we see it 
do in most fevers, the obstruction which the torpid capillaries 
offer causes the blood to be principally in the arteries ; 
hence the whole person looks full, the face is flushed, the 
eyes red, etc. We now have arterial congestion ; but when 
the heart beats feebly and the blood is not passed on by 
the capillaries, it must of necessity accumulate in the veins, 
and especially in the great internal veins, which are not 
surrounded by muscles as those externally are, especially 
of the limbs, by whose contractions the blood is forced 
onward, and no great accumulation can take place in them. 
The prominent symptoms of a congestive chill can therefore 
be accounted for as follows : the great nervous depression 
causes a feeling of languor, feebleness, helplessness — the 
little force given to the blood by the weakened heart is not 
sufficient to send it through the lungs with the rapidity 
necessary to keep up such a degree of vitalization of the 
whole mass as is necessary for the supply of the system ; 
hence the blood, for want of the proper changes which it 



150 on fever: 

should receive in the lungs, becomes dark, and, being 
partly stagnant in the capillaries, imparts a dusky or 
bluish appearance to the whole surface. This imperfect 
vitalization of the blood is the chief cause of that inde- 
scribable sense of sinking and restlessness which is often 
so distressing a feature in this disease. The patient 
rolls from side to side ; sighs deeply, as though in great 
trouble; and yet, if interrogated, cannot tell why he does 
so ; there is often no positive pain or sickness, and yet the 
distress is such that it would be willingly exchanged for 
either or for both. In the worst cases there is no sense of 
chilliness ; I have said in another place that chill was the 
result of nervous reaction, and here the nervous prostration 
is too profound for that. In milder cases there is partial 
nervous reaction — -just enough to give a mixed feeling of 
heat and cold — the patient feeling as though he had chill 
and fever at the same moment. Now although there is 
great nervous prostration, and, as a consequence, extreme 
general debility and insensibility, yet the nerves of feeling 
are not insensible to impressions ; on the contrary, they are 
morbidly sensitive, so that causes will produce keen suffer- 
ing which ordinarily occasion none, or even a pleasurable 
sensation ; hence, though the patient feels cold to another, 
the sensibility to heat is so acute as to cause the sensation 
of heat to him, and for this reason hot applications are quite 
unbearable, and will do much injury if persisted in. There 
is no one symptom so diagnostic as this j that is, nothing 
else can be so safely relied on as this symptom in deciding 
whether a fever is really what we mean by congestive or 
not. It is true we see the same condition in the last stage 
of cholera, and in severe hemorrhage, [bleeding,] and from the 
same cause, viz. : from great loss of vital energy, sensibility 
always being found in an inverse ratio to vital energy ; 
hence, the strong man will hardly notice causes which pro- 
duce in the delicate female great suffering ; but this strong 
man may be brought, in a few hours, by the poison of 
malaria, or cholera, or from loss of blood, to the weakness 
of a child and the sensibility of a delicate, nervous woman. 
It is a favorable omen for the patient, after suffering from a 



CONGESTIVE CHILLS. 151 

sensation of heat while feeling cold to others, to complain 
of chilliness, for it shows that nervous reaction has com- 
menced ; and this will usually soon be followed by arterial 
reaction, which, when established, removes all present 
danger. 

I think the reader will now be able to recognize a case 
of congestive fever when he sees it, and will have some 
tolerably clear ideas of the true condition of the patient — 
that is, what gives rise to the prominent symptoms — and 
will now be better prepared to understand the reason for 
using the remedies which I will now recommend, and even 
resort to other appropriate means, should these not be at 
hand. I am aware that a medical work intended for 
families is expected to be composed only of plain, practi- 
cal directions for managing the various diseases to which 
we are liable, and that the common reader should not be 
bored with explanations of the reason of things ; and this 
idea has been the cause of the almost universal failure of 
such works becoming useful. No person, physician or 
nurse, can safely administer remedies without some reason- 
able idea of what they wish to accomplish, and how the 
means will act in accomplishing the end ; and in almost 
every family there will be found some member who has 
capacity for, and will take a delight in, studying these 
things so as to understand them. The fact is, people love 
to think, and any subject, however scientific, if presented 
in such a way as to be easily comprehended, and in lan- 
guage which can be understood without much effort, will 
interest every reader who has a reasonable share of common 
sense and the usual amount of curiosity. I say curiosity, 
for the same kind of impulse which will prompt a person to 
desire to see new things, will also influence him to seek to 
understand new ideas ; and as women are supposed to 
possess more curiosity than men, I expect them to read my 
book more, and understand it better, than men ; and this 
is as it should be, for women are the natural family physi- 
cians, as well as the careful nurses. 



152 on fever: 



TREATMENT OF CONGESTIVE FEVER. 

This, like the milder grades of bilious fever, may either 
be remittent or intermittent — distinguished by the terms 
congestive fever and congestive chills. But there is not much 
foundation for thus dividing the disease, as, in every case 
which is grave enough to be dignified by the term congestive, 
the fever does not entirely go off before the accession of 
another paroxysm or chill; when it does go entirely off, 
the next chill will be of the ordinary kind. I will, there- 
fore, only speak here of congestive fever of the remittent 
type, as the directions already given are amply sufficient to 
enable any one to manage that form which presents perfect 
intermissions. 

I have already said that this disease requires prompt and 
decisive treatment ; but this being of the very same nature 
of the milder grades of bilious fever, the same general plan 
of treatment is equally applicable to it as to the others, 
only graduating the force of the means to the violence of 
the case. I therefore commence with this fever as I do 
with all others, viz. : give the fever syrup, apply the chlo- 
roform liniment, etc., but the syrup must now be given 
heroically — as much as four ounces has been sometimes 
given at once, and repeated in an hour. If this should not 
be at hand, stir a teaspoonful of ground mustard in a glass 
of cold water and give it at once : if it vomits, as it pro- 
bably will in a few minutes, it is all the better, as the effort 
of vomiting will aid powerfully in throwing the blood to 
the surface, and in expanding the lungs. But if it should 
not vomit, it will do no harm, but will act as a powerful 
general stimulant through the medium of the sympathies 
that exist between the stomach and the rest of the system. 
Cold water is usually craved, and should be indulged in 
freely, for, though the surface may be ever so cold, there is 
great internal heat, as will be shown by the contents of the 
stomach coming up hot. But if the vomiting should con- 
tinue so as to weary the patient, a mustard poultice must 
be applied to the stomach, and to the arms between the 
shoulder and elbow. I cannot account for it, but a blister, 



TREATMENT OF CONGESTIVE FEVER. 153 

or stimulating poultice, applied to this part of the arm, will 
exert a greater control over the stomach than if applied 
directly over it, but it is well to do both. At the same 
time, a full dose of paregoric, Bateman's drops, or morphine, 
or opium, should be given ; a tablespoonful of the drops, or 
a grain of morphine, or two grains of opium, will not be too 
much for a strong man, and less for a woman or child. The 
opiate will not only be beneficial in arresting the vomiting, 
but will materially assist in getting up reaction. I always 
direct mustard plasters to the feet, and hot bricks to keep 
them warm until the patient complains, and then remove 
the bricks. As soon as there is some evidence of reaction, 
a sheet, folded into proper size and saturated with cold water, 
should be wrapped around the body and covered with a dry 
blanket; as soon as it feels unpleasantly warm to the 
patient, it should be immersed again in cold water and 
reapplied; cold may also be applied to the head; ice, or 
iced water, or lemonade, may be allowed in small quantities 
between spells of vomiting, and if there is no vomiting, 
they, or any other mild cooling drink, can be allowed freely. 
After reaction has been pretty well established, the fever 
syrup should be given in tablespoonful doses every two or 
three hours ; and, as the patient is now usually very 
thirsty, it may be given in a glass of cold water ; quinine 
should now also be given quite liberally, but not in the 
unreasonable, and, I think, dangerous quantities recom- 
mended by some — given at the same time with the syrup, 
or combined with it; from two to five grains given every 
three or four hours will be sufficient. It should always be 
carried to the extent of producing slight ringing in the ears, 
and then the quantity lessened : this is the only means we 
have of knowing when the dose is sufficient; it must 
impress the nervous system, and some cases will require 
five times the amount to do this that is sufficient in others, 
so that I always make it a rule to commence with two 
grains, and increase each dose one grain until this effect is 
in some measure produced, and then drop back to a smaller 
quantity. In this way I am almost certain to save my 
patient from the danger of another paroxysm, and, at the 



154 on fever: 

same time, run no risk of impressing the system too much. 
By giving the syrup at the same time with the quinine, it 
insures^ its action on the surface, and prevents any lasting 
unpleasant effects upon the head; in fact, I have several 
times given the quinine and syrup freely in conjunction to 
patients who, on some former occasion, had taken quinine 
in injurious quantities, so as to occasion continued ringing 
in the ears and indistinctness of hearing, with the effect of 
completely removing these unpleasant effects, though they 
had lasted for years. 

It is hardly necessary to give the treatment recommended 
by standard authors in this disease, as it is little else than 
that which was pursued twenty years ago, viz. : vomiting, 
bleeding, the daily use of calomel, blistering, etc.', etc. The 
injurious effects of this treatment have been so fully dwelt 
on in the preceding pages, that nothing more is necessary 
to be said upon the subject here. But, though authors con- 
tinue to recommend this mode of treatment, it is evident 
that they have but little confidence in it. Dr. Watson says : 
" Boerhave, in the preface to his Aphorisms, professes that 
( he knows of nothing which can be fitly termed a remedy? 
In fevers, the wisdom of this maxim is eminently conspicuous ; 
the rational objects of treatment are, to mitigate the urgency 
of symptoms that cannot be wholly subdued; to redress 
(as far as art may redress) those dangerous complications 
which are incidental, but not essential, to the disease ; and 
to aid the conservative efforts of nature, when these mani- 
festly languish and fail." Now I claim for the plan of 
treatment laid down in this book that, taken as a whole, it 
is a remedy in the fullest sense of that term ; that is, if pro- 
perly pursued, in the early stages of fever at least it will 
cure fever, as external inflammation is often cured by a 
timely use of poultices, etc., or as the toothache is cured 
by extracting the offending member. 

PULMONIC OR LUNG FEVER PNEUMONIA. 

Pneumonia has been placed by authors among the inflam- 
mations, and considered by them simply as inflammation of 
the lungs. I think this classification calculated to mislead; 




A SIDE VIEW OF THE SUPERFICIAL ARTERIES AND 
VEINS OF THE FACE AND NECK. 




A VIEW OF THE BRONCHIA AND BLOOD-VESSELS OF THE 

LUNGS, AS SHOWN BY DISSECTION, AS WELL 

AS THE RELATIVE POSITION OF THE 

LUNGS TO THE HEART. 



PULMONIC OR LUNG FEVER PNEUMONIA. 155 

for though there is always inflammation when this disease 
is fully formed, yet that does not generally constitute the 
most prominent feature in the disease. It is always ushered 
in with the common symptoms constituting the first stage 
of fever, which often precede any distinct evidence of pul- 
monary disturbance ; and, if properly treated in this stage, 
may be aborted, and no inflammatory action be developed : 
or, in very grave cases, the nervous prostration and con- 
gestion may be so overwhelming as to destroy life before 
any symptoms of inflammation of the lungs have appeared. 
With this view of the subject, I have thought proper to 
class it with particular fevers, it presenting all the essential 
elements of fever, to which the disturbance in the lungs is 
added, either by the action of exposure to cold and wet, or 
by some peculiar condition or epidemic influence in the 
atmosphere, which determines the fever to affect the lungs 
rather than any other portion of the system. 

Pneumonia, it has been said, is ushered in with the 
symptoms common to almost all febrile diseases, viz. : list- 
lessness, languor, aching of the back and limbs, sense of 
weakness, etc., with more or less of the symptoms of 
catarrh, or common cold, viz., more or less chilliness, some- 
times a distinct chill, always attended with an uncomfort- 
able sense of tightness in the chest, or the feeling occasioned 
by breathing a very dense or impure atmosphere. When 
the period of reaction is ushered in, there is, in addition to 
the symptoms common to febrile excitement, viz., headache, 
throbbing of the heart and arteries, increased heat of the 
skin, either general or partial, etc., also more or less dull 
pain in the chest, generally only on one side ; sometimes 
there is also acute pain, which appears to be immediately 
under the ribs, which arises from a part of the pleura, or 
membrane which lines the ribs and forms an outer covering 
for the lungs, being also inflamed. This membrane pos- 
sesses great sensibility, and when inflamed gives acute 
suffering, the patient feeling sharp or lancinating pain every 
time the ribs are moved in breathing ; but the substance of 
the lungs possesses very little sensibility ; hence inflamma- 
tion in them causes only a dull or aching pain. When the 



156 ON FEVER : 

lungs only are inflamed, the disease is called Pneumonitis, 
or Pneumonia ; and when the pleura only is affected, it is 
called Pleuritis, or Pleurisy ; and when both are involved, 
it is known as Pleuro-Pneumonia. 

There is always, in this stage of pneumonia, a good deal 
of cough ; at first it will hardly draw attention, either from 
the patient or friends, but as the disease progresses it be- 
comes harassing, being dry and almost incessant. At first 
there is nothing raised, but presently a little white frothy 
mucus, often slightly streaked with blood, is spit up after 
a hard spell of coughing ; afterward the sputa [matter spit] 
becomes discolored, assuming a grayish, or greenish, or 
reddish hue, sometimes mixed with pure blood. The 
patient is inclined to lie on his back with the head higher 
than usual, and the difficulty of breathing is now quite dis- 
tressing, attended with a good deal of pain in some part of 
the chest, generally of the right side, and below the middle 
rib ; if the pleura is inflamed, the pain is severe and dart- 
ing, causing the patient to hold the ribs as still as possible, 
and breathing almost entirely with the diaphragm and ab- 
dominal muscles ; hence, a practiced eye can decide at a 
glance if pleurisy be connected with pneumonia, by the 
heaving of the abdomen. But the most certain means of 
determining whether a case be pneumonia or not, are what 
are known as the physical signs ; and these can be very 
readily learned by any person who has a good ear and will 
give the subject a little attention. Now in order to be pre- 
pared to decide when any thing is wrong, you must first 
become familiar with the signs when every thing is right. 
A few plain directions will enable you to do this. And, 
first, of percussion. Place the fingers of the left hand flat 
upon the chest, and gently tap them with the ends of those 
of your right hand ; if the lungs are in a sound condition, 
the sound will be that presented by tapping a hollow sub- 
stance. You may soon familiarize yourself with this sound 
by first tapping the chest and then the thigh. You must 
recollect that the sound is always dull over the heart, which 
is near the centre of the left side, and over the liver, which 
occupies the lower third of the space within the ribs on the 



PULMONIC OR LUNG FEVER PNEUMONIA. 157 

right side. Now, when you have become familiar with the 
sound produced by percussion, you can be able to detect a 
very slight change in the condition of the lungs, though it 
should be circumscribed within a small space. But as 
there are many causes that may occasion a flat or dull 
sound on percussion besides pneumonia, you cannot by this 
alone decide whether that disease is present or not — all you 
can know by it is, whether the patient breathes through all 
the lungs or not ; for if the air vesicles are pervious and 
admit the air, the sound will be hollow, and not flat. But 
next, you must test it by auscultation ; that is, by listening 
to the sounds within the chest. An instrument called a 
Stethoscope is generally used by physicians in listening for 
respiratory sounds ; it very much increases the force of the 
sounds, but to an unpracticed or very sensitive ear, it 
gives a confusion of sounds ; and as I know by experience 
that the ear, placed in contact with the chest, with not 
more than one or two garments between, can distinguish with 
sufficient accuracy all the leading sounds from each other, 
I therefore recommend you to practice with the ear alone, 
without any instrument. If the breathing is natural and 
the lungs sound, you will, after composing yourself and 
listening attentively, be able to hear what is called the 
respiratory murmur. I have thought it resembled the mur- 
mur of a gentle breeze among thick foliage more than any 
thing else ; but every one must learn to distinguish it for 
himself. In children this respiratory murmur is louder and 
a little rougher than in the adult ; and when there is excite- 
ment in the lungs as in common cold, or the forming stage 
of pneumonia, the murmur resembles that heard in the 
child, and is known as puerile respiration. Now in the first 
stage of pneumonia, when the frothy expectoration spoken 
of is present, the air, passing from the air vesicles through 
the mucus in the minute branches of the bronchia, causes 
a succession of little bubbles to form and then burst, pro- 
ducing a slight crackling noise which has been compared to 
the crackling of grains of salt thrown upon a hot surface, 
and is known as minute crepitation. In a more advanced 
stage of the disease, when a tenacious mucus has accumu- 



158 on fever: 

latecl in the larger bronchial tubes, the same thing takes 
place in them; and, as the bubbles now are larger, the 
noise occasioned by their bursting will be louder, and is called 
large crepitation. Now if the air-cells have become filled 
with a coagulable deposit, and the minute bronchial tubes 
also obstructed so that no air passes through them, you 
cannot hear any of the sounds mentioned, but you will 
hear a kind of whistling sound, produced by the forcible 
passage of air through the partially closed larger bronchial 
tubes, and known as bronchial respiration. 

Having learned this much, you are prepared to decide 
positively when a person has pneumonia ; also to determine 
the exact stage of the disease, and be able to form a pretty 
accurate judgment as to whether the case is a dangerous 
one, or whether it is likely to terminate favorably. 

In order to impress what has been said upon your mind, 
and make you familiar with it, we will now take up a case 
of pneumonia, and trace it through its various stages, 
either to health or dissolution. Suppose we visit a case, 
and find the general symptoms of fever, with a rather un- 
usually flushed countenance, breathing rather laborious, 
some pain, either dull or sharp, in some part of the chest, 
considerable cough, and occasionally some white frothy 
matter expectorated, the patient lying on his back of 
choice, with his head raised higher than usual — we have 
good reason to suspect pneumonia in its first stage ; and 
if we now place our ear to the chest, we will perceive the 
minute crepitus over a greater or less extent of lung ; per- 
haps we may also hear a slight respiratory murmur com- 
bined with it, for the air may yet be entering some of the 
air-cells. But if the disease be suffered to progress, and 
we examine the case some two or three clays later, we will 
not only have presented a flatter sound on percussion, but 
we will find, upon listening, that the respiratory murmur 
and the minute crepitation are both gone, and no sound is 
heard but either the whistling of bronchial respiration, or 
the great crepitation, or both combined. We now know 
that we have pneumonia in its second stage — that the air- 
cells and minute bronchial tubes are filled up by coagula- 



PULMONIC OR LUNG FEVER PNEUMONIA. 159 

ble matter so as to be impervious to the air; and if the 
lung were now cut into, it would present very much the 
appearance of Ever, the engorged capillaries giving it the 
color, and the morbid deposit in the cells giving it the 
solidity, of liver; but if nature, or proper remedies, have 
brought the system to the secreting point, a free secretion 
of mucus may give us at this stage the large crepitation ; 
but if the fever has progressed, the bronchia will be dry, 
and we will only hear the bronchial respiration.- Now the 
patient cannot remain long in this condition; the disease 
w T ill probably soon terminate in one of two ways : either 
this morbid deposit in the cells will be taken up by the 
absorbents, and the air be again admitted, and we again be 
greeted with the minute crepitation, or softening will take 
place, and the substance of the lungs destroyed, forming a 
case of acute consumption ; or pus may be infiltrated into 
the meshes of the cellular membrane, and in the bronchia ; 
we will then have difficult and laborious breathing, con- 
nected with an abundant expectoration of pus and mucus. 

The patient may survive this condition, but the chances 
are doubtful. We are now prepared to understand the 
reason or the rationale of the treatment — which we will 
next consider. 

The fever which accompanies pneumonia may either be 
of a high inflammatory grade, or it may be ordinary bilious 
remittent, or it may be congestive, or it may be ty- 
phoid. Now the great difficulty with physicians has been 
to decide upon the type or grade of the fever ; for, accord- 
ing to the usual mode of treatment, a mistake may cost the 
life of the patient ; but that difficulty, and that danger, are 
entirely removed by my method of treating fever; for the 
reader who has followed me thus far, knows that my plan 
of treatment is equally applicable to every type of fever, 
and equally successful — more successful, as can be estab- 
lished by proof that cannot be set aside, than any other of 
which we have any history. I therefore treat the fever 
attending pneumonia as I do all others. I give the fever 
syrup in such doses, and repeated at such intervals, as will 
insure a good capillary action ; and in obtaining this I have 
11 



160 on fevek: 

also gone very far toward relieving the lungs. In the 
forming stage nothing else is needed, for to put the capilla- 
ries into active exercise is to remove the engorgement, or 
congestion, in which the disease of the lungs then consists. 
When the first stage is fully formed, it is safest to assist 
the action of the syrup with other means — a grain of tar- 
tar or two grains of ipecac, may be put into a glass of cold 
water, and a tablespoonful given every hour. If the cough 
be troublesome, a grain of morphia or thirty drops of 
laudanum may be added ; chloroform liniment should' also 
be freely applied to the spine and to the breast, and cloths 
wrung out of very warm water applied to the chest, and 
frequently repeated. Now if the fever be typhoid, this is 
emphatically the treatment; and if it be bilious, it will 
equally succeed; and even should it be inflammatory, 
nothing else is necessary, except that the nauseants should 
be pushed a little farther ; but in no case should they be 
carried beyond slight nausea. If the case shows, in its 
progress, that it is bilious remittent, it will be safe, and 
best, to give ten or fifteen grains of calomel, and follow it 
with castor oil in three or four hours ; for, by exciting and 
disgorging the liver, we lessen the labor of the lungs ; and 
after the bowels have been well moved, quinine and opium 
may be given. I usually in these cases prescribe ten 
grains of sul. quinine, five grains of Dover's powder, and 
five of gum-camphor ; make four pills, and direct one to be 
given every three or four hours. 

But as example is more striking than precept, I will 
present the reader with the history of the treatment of a 
very violent case of this disease, which I managed during 
the winter of 1854. The patient was a Mr. T. of this city, 
a young man of intemperate habits, and who had been, for 
some weeks previous to the attack, most of the time intoxi- 
cated. This being the case, his friends looked upon his attack 
as nothing more than a cold, and neglected to apply for 
medical aid until the disease had progressed a number of 
days. When I saw him, the powers of life were very nearly 
overwhelmed. His breathing was exceedingly hurried, 
attended with an incessant hacking cough, and no expecto- 



PULMONIC OR LUNG FEVER— PNEUMONIA. 161 

ration whatever ; his pulse was frequent, (about one hun- 
dred and fifty,) but had very little force or volume ; no 
respiratory sounds whatever could be heard by placing my 
ear to the chest; his eyes were deeply injected, and his 
face flushed, with livid blotches ; the under side of his face, 
and even of his arms and body, presented the appearance 
usually seen some hours after death, occasioned by the 
blood settling in the capillaries of the dependent parts ; his 
extremities were cold and shrunken, and altogether he 
presented a state of the system in which there can be but 
little hope of a successful reaction. But I resolved on 
making an effort, and accordingly ordered hot water pre- 
pared, and a number of bricks to be warmed. For although 
I did not presume that the prolongation of the life of the 
patient would pay for the smallest outlay of skill, yet, as a 
test of the powers of the mode of treatment, it might be of 
immense value. I accordingly devoted as much time to 
seeing that the plan of treatment was duly carried out as 
was compatible with other duties, and thus saw that the 
directions were fully carried out, viz., that the whole chest 
should be enveloped with the cloths wrung out of warm water, 
and repeated every ten or fifteen minutes ; that the extremi- 
ties be kept warmed by the imparted heat of hot bricks, 
etc., etc. I gave him a tablespoonful of the syrup every 
hour, in half a glass of water, and allowed him no other 
drink. After the lapse of twelve hours I discovered the 
following changes : his cough was not so incessant, but 
when he did cough, it was attended with a free expecto- 
ration of exceedingly offensive matter, such as evidently 
had been accumulating in his lungs for days ; his pulse was 
less frequent, and his skin and tongue showed a little 
capillary action. On listening for sounds in the chest, I 
now discovered a distinct tubular sound. The same treat- 
ment was continued for another twelve hours, when I 
thought best to discontinue the use of the hot cloths, and 
cover the whole chest with a fly-blister. At this time, in 
addition to the tubular sound, I discovered some crepitus, 
and a little afterwards the real mucous rale, showing that 
the air was having access into not only the smaller bronchial 



162 on fever: 

tubes, but also their minute ramifications ; twelve hours 
later, the blister had drawn well, and as a result of this, 
and the general stimulant effect of the syrup, the breathing 
was much easier, the expectoration freer, causing little 
effort, the pulse had sunk to one hundred, the countenance 
looke*d more intelligent and life-like, the skin had lost its 
mottled hue, and the lungs produced a sensible respiratory 
murmur over a part of their surface ; the tongue was yet 
red and pointed, and trembled as it usually does in the 
second week of typhoid fever, and the strength exceedingly 
little, and mental effort almost nothing, the patient seeming, 
though rational, to have the mind of an infant. The blister, 
as the sensibility was very low, caused no suffering of con- 
sequence, but produced a most happy influence upon the 
irritability of the capillaries, causing those of the lungs to 
act more vigorously by direct association, and those of the 
general system to feel the impression through the nervous 
centres ; the result was, that there was a general amend- 
ment. 

The blister, however, soon seemed to lose its effect, and 
the hot cloths were obliged to be again resumed, to keep 
up that amount of action in the pulmonary capillaries which 
is indispensable to the performance of the function of , the 
lungs sufficiently to continue life at all. But by persever- 
ing in the use of these means as occasion required, and a 
regular use of the syrup, the system was kept in that con- 
dition which enabled the recuperative powers to act with 
such efficiency that eventually a healthy action was estab- 
lished, and the patient slowly recovered. No medicine 
was given internally during the entire term of treatment 
but the syrup ; being resolved, as the patient's life was 
probably of no other advantage, to make it of value in 
establishing the fact that this medicine, with the aid of 
external means, was capable of meeting the very lowest 
condition of vital action compatible with life. Mr. T. has 
regained his usual health, and has been able to stand the 
effects of many drunken sprees since then. 

By relying so exclusively on the syrup in the above case, 
I did not suppose I was at all jeopardizing the patient's 



PULMONIC OR LUNG FEVER — PNEUMONIA. 163 

life for the sake of experimenting, for I had treated many 
cases of pneumonia previously upon the same plan, with 
entire and prompt success, but have not always confined 
myself to that alone. In cases in which there is a good 
deal of spasm in the lungs, and in such as manifest much 
active inflammation, I give emetic tartar in sub-nauseating 
doses, until these symptoms are abated. I have not resorted 
to the lancet, even in pleuro-pneumonia, for several years, 
except in one single instance, and then I thought my patient 
was damaged by it. 

Below are a few extracts selected from many others of 
the same kind upon this subject. 

J. E. Fulton, M. D., Big Oak, Miss., says : 
"During this winter (1858) I have had seven or eight 
cases of typhoid pneumonia, in the treatment of which I 
have confined myself entirely to your practice. No deaths ; 
the recovery from eight to twelve days ; and upon the 
whole my experience goes to warrant me in the conclusion 
that if your plan is assiduously followed out in typhoid 
cases, the result will be universal success." 

J. W. Steele, M. D., Charleston, Miss., writes : 
"We have had a great deal of pneumonia this winter, 
(1858.) Most of the cases that I have had I believe would 
have been typhoid had I not aborted them. I have had 
but one case to last over five days, and that was an old 
man near seventy years old ; he was down about two weeks. 
I seldom ever give any thing except the syrup and nause- 
ants. The syrup meets every indication. Other doctors 
lose about one-third of their patients." 

W. Kirk, M. D., Buckhorn, Miss., writes : 
" Typhoid pneumonia has been prevalent here this winter, 
(1858,) and I have succeeded in curing every case so far. 
I have always used your syrup when the cases have been 
ushered in with a chilly sensation, and I know of nothing 
equal to it in producing a reaction." 

The treatment recommended by standard authors in 
pneumonia is generally of the ultra debilitating kind, such 
as was pursued twenty years ago. Wood, Watson, Bartlett, 
all advise a bold antiphlogistic treatment, which consists in 



164 ON FEVER : 

a liberal use of the lancet, tartar emetic, mercury, and low 
diet. However, in the last edition of Watson, he modifies his 
practice in this and other inflammatory diseases very 
materially, confining the use of the lancet to cases of the 
highest grade. M. Lois, of Paris ; Bennett and Tanner, of 
London, and many others, have also discovered that inflam- 
matory diseases have heretofore been treated too actively ; 
that is, depressing measures have been carried too far ; and 
they now pursue a milder plan, one which does not so 
speedily exhaust the energies of the system; so that my 
plan is now in harmony with the general tendency of the 
age, which evidently leans to the adoption of milder mea- 
sures. But the utmost extent of the reformation is, that 
some have "ceased to do evil :" they have not yet "learned 
to do well;" in this I claim for my plan of treatment a 
decided preeminence, for it not only does not exhaust the 
vital powers, but sustains them ; and though the remedies 
used will not make a well man sick, they yet possess great 
power in controlling disease. 

YELLOW FEVER. 

Never having seen this disease, it may be considered 
rather presumptuous to attempt to form any judgment con- 
cerning it differing from that of those who have studied it 
at the bedside. But during the excitement of an epidemic, 
physicians are usually not in the best frame of mind to 
philosophize upon the facts presented by the suffering and 
the dying. It is only after the battle is over that a cool 
survey can be made of the battle-field, and just estimates 
formed of the positions which the foe assumed, and the 
relative advantages of different means which may have 
been taken for repelling or circumventing him ; and one who 
took no part in the contest, and, consequently, has not his 
own actions to justify, will be more likely to perceive where 
an error had been committed or an advantage neglected, 
than those who were identified with the conflict. I have 
carefully studied the history of this dreadful disease as 
given by those who have contended with it, and impartially 
compared the various modes of treating it which have been 



YELLOW FEVER. 165 

adopted by those who have been most successful, so as to 
be able to determine, if possible., upon what the success of 
each depended, and wherein all fall short of meeting the 
requirements of the case, and will now give the reader the 
result of my reflections. 

The best description I have seen of this disease, and the 
most rational mode of treatment, attended with the largest 
success, I find in the Proceedings of the National Medical 
Association for 1854, by Dr. Fenner, of New Orleans. 

Dr. Fenner agrees with most other writers who have 
closely observed the commencement and spread of the 
disease, that it has a local origin, and spreads from the point 
of commencement, not by being carried by persons, but by 
an extension of the infected atmosphere ; and that, when 
once originated, nothing but a reduction of temperature will 
arrest its progress. Dr. Caldwell, upon this subject, says : 
"The fact, as here stated, is true, and the problem it pre- 
sents is difficult of solution : when an epidemic yellow fever 
has begun its career, in one of our large commercial cities, 
nothing but a termination of warm weather can arrest it. 
Local nuisances may be removed, the inhabitants of the 
city may fly, man may erect artificial barriers, currents of 
water may be made to flow along the gutters, rains may 
fall and wash the entire streets, and the winds may blow 
and change the atmosphere of the place, but all to no pur- 
pose. If the temperature of the atmosphere continues 
high, the epidemic mocks at resistance, until it expires 
under a regular change of season." Now, were this poison 
a gas, evolved by the decomposition of animal or vegetable 
matter, would not removing the filth stay its production ? 
Would not rains wash it away, or winds disperse it ? But 
as none of these things are so, then the poison is not a gas, 
but must be something which has in itself the power of 
increase, which can retain its position by its own powers in 
opposition to wind and currents of water, and which can 
direct its own course, so that when once it has obtained an 
existence, it multiplies independent of the original source, 
and travels "whithersoever it will," independent of currents 
of commerce or currents of air. It must then be an organ- 



166 on fever: 

ized existence, having a will, or being directed by instinct, 
and increasing by natural propagation. 

The cause of yellow fever therefore is, as I believe, 
poisonous animalculse. The effect produced upon the sys- 
tem by this poison is much allied to that arising from the 
malaria which causes bilious fever. 

The symptoms of the first stage of yellow fever, as de- 
scribed by Dr. Fenner, are precisely such as we see in the 
same stage of high grades of bilious fever. The patient 
felt chilly, with headache and pain in the back, etc. Went 
to bed, and covering up warm, a high state of excitement 
was soon developed, viz. : violent pains in the head and 
back; skin burning; countenance flushed and swollen; 
eyes red ; pulse frequent, full, and bounding ; thirst in- 
tense; stomach uneasy, sometimes nausea and vomiting; 
restlessness, etc. He says, it is evident the symptoms 
plainly indicate super-excitement of the whole system, and the 
principle to be acted on is, a to restore the equilibrium of the 
circulation and the excitement." Now there is some mistake 
here ; if there were really super-excitement of the whole 
system, there would be harmony of action, and there could 
be no necessity for efforts to restore the equilibrium. It is 
exactly because there is not a general over-excitement, that 
we are called on to interfere. There is great partial super- 
excitement, but it is not general, or the patient would be no 
worse off than when taking vigorous exercise in obedience 
to some strong mental impulse. The history of the case 
up to this time is as follows : a morbid agent has entered 
the system, and has produced a powerful impression upon 
the nervous system ; so powerful that it has been for the 
time overwhelmed, and the usual amount of nervous influ- 
ence not sent out to keep up the various operations of life ; 
hence the chilliness and inclination to go to bed, etc. But 
presently the nervous system reacts, and a powerful im- 
pulse is sent to every part. The heart and arteries act 
with unusual power, and the blood, which had been accu- 
mulating in the large veins, is sent with force throughout 
the system ; and did it not meet with resistance, if there 
were no obstruction anywhere, an equilibrium would unques- 



YELLOW FEVER. 167 

tionably soon be established. But there is an obstruction : 
the capillaries have been debilitated by the same cause 
which irritated the nerves, and they refuse to pass the 
blood on with the rapidity which would be in harmony with 
the action of the heart and arteries. Hence a distension 
of the capillaries takes place, giving rise to the suspension 
of the secretions, swelling and flushing of the countenance, 
redness of the eyes, restlessness, etc. Now what does this 
view of the condition of the patient indicate should be 
done? The doctor says, truly, that "the overheated skin 
must be cooled, the accelerated pulse must be retarded, the 
distressing pains, thirst, and restlessness must be relieved. 
These desirable results may doubtless be effected by differ- 
ent means, but that is the best method which accomplishes 
the object most promptly, effectually, and safely!' All 
those indications I believe would be met by my fever syrup, 
promptly, effectually, and safely. By soothing the excited 
nerves, and restoring the action of the capillaries, the whole 
of the phenomena would cease at once. Why this should 
be so is plain enough : the obstruction in the capillaries to 
the onward flow of the blood is unquestionably the cause of 
the protracted increased action of the heart ; the dilatation 
of the capillaries also causes the pain and restlessness, by 
compressing the fine nervous expansion in their coats, and 
in the interstices between these minute vessels ; the heat 
is also occasioned by this congestion, so that restoring the 
action of the capillaries will necessarily remove all febrile 
phenomena. But in this, as in other forms of fever, if the 
case were obstinate, I should call to my aid every other 
appliance which could be made to operate in unison with 
the principal remedy. The nervous excitement could be 
greatly controlled by stimulating anodyne liniments ; the 
heat of the surface by sponging with cold or tepid water. 
But 1 should never think of bleeding, unless there were 
actual inflammation. Mere over-action and super-excite- 
ment can always be subdued by the means I have stated, 
without lessening the fountain of life upon which we must 
depend for the final restoration of health ; and if the cause 
be a poison still floating in the blood, and by its continual 



168 on fever: 

action keeping up the disturbance, taking away a part of that 
fluid will not lessen the proportion that will be left in what 
remains, or materially reduce the whole quantity, unless it 
should be carried to the extent of the case named by Dr. 
Fenner, when near a hundred ounces had been abstracted, 
(one gallon ;) in this case the poison must have been pretty 
well eliminated from the system, as the man could have had 
but a small quantity of blood left to contain it. But I 
should by no means have been surprised, as was Dr. Fen- 
ner, by his dying of hemorrhage in the form of black vomit. 
Such a loss of blood and vitality ought to produce a state 
of relaxation in the capillaries which would allow the 
blood to pass unchecked through all the mucous mem- 
branes. 

I would suggest to any one disposed to test this mode of 
treatment, that, in consideration of the great irritability of 
the stomach, which is often present, it would be well to 
first apply a cloth saturated with chloroform liniment to the 
epigastrium, and as soon as it begins to burn considerably, 
give the syrup in a decided dose — say two ounces. If this 
be rejected, repeat it immediately, even to the third time ; 
but when a dose has been retained, give no more for two 
hours, withholding all drinks ; by this time the medicine 
will have produced its peculiar effects, and drinks may be 
allowed as desired. 

Believing, as I do, that the cause of yellow fever, though 
not the same, is allied in its nature to that which produces 
bilious fever, and that the condition of the system in both 
is much the same, I would expect to arrest it by much the 
same means. The course of treatment which has been sug- 
gested to my mind by the symptoms, as described by accu- 
rate observers, is as follows : 

I should bathe the spine and epigastrium with chloroform 
liniment^ or laudanum, camphor, and turpentine ; give the 
comp. syrup of valerian in such quantity as the condition 
of the s}*stem would indicate ; if vital action seemed to be 
very low, I should give it as in congestive fever, two or 
three ounces at a time ; I would, at the same time, give 
quinine and blue-mass in the form of pills ; apply an emol- 



DYSENTERIC FEVER. 169 

lient poultice to the abdomen, sinapisms to the feet, and 
cold applications to the head. 

Under the influence of this treatment, I should expect 
all my patients to recover rapidly, unless the constitution 
had been previously much injured by other causes, or this 
disease had been suffered to run until serious lesions had 
been produced in vital organs. I hope some one may be 
influenced to give this plan of treatment a trial, should this 
dreaded disease again visit our land. 

DYSENTERIC FEVER DYSENTERY FLUX. 

As Dysentery, as well as Cholera Infantum, are only 
serious diseases when attended with fever, I have thought 
best to include them as sections under this chapter. 

Perhaps the author cannot produce any thing better upon 
this subject than is contained in an article prepared by 
him, and published in the Nashville Journal of Medicine 
and Surgery, March, 1853. This article was written soon 
after the author had been engaged in contending with Epi- 
demic Dysentery in the worst form in which he ever wit- 
nessed it; and as it contains much important truth, and has 
a freshness of thought and accuracy of description, the re- 
sult of a strong impression which the disease had then re- 
cently made upon his mind, he has concluded to copy it entire : 

Prof. Bowling: — In the 2d volume (p. 188) of your 
Journal, you published a note from me upon the use of 
peach leaf in dysentery. Since then I have had a pretty 
large experience in that disease, and as I found it necessary 
to vary my treatment somewhat, I will now, with your 
permission, offer a few additional remarks upon it. 

In July last the flux made its appearance on the southern 
border of my practice ; and although it was confined to a 
few families, yet for a while it gave me a good deal of 
trouble. It did not yield readily to the influence of my 
favorite remedy ; a main reason was, that there was great 
gastric distress, with frequent vomiting or inclination to 
vomit, so that the tea could not be retained long enough to 
be of any benefit. 



170 on fever: 

The tongue was usually thickly coated in the middle 
with white fur, and red at the edges ; pulse small and 
corded; surface covered with a disagreeable perspiration, 
sometimes profuse and general, sometimes partial and alter- 
nating with a dry, hot surface ; extremities generally rather 
cool, often quite cold ; almost all complained of a burning 
sensation in the region of the sternum, commonly about its 
middle ; the discharges from the bowels were generally 
small, and composed of blood and mucus, and attended with 
tenesmus ; the worst case, however, had no tenesmus, and 
the discharges were more copious, and consisted of a red- 
dish jelly. Finding I had a more formidable enemy to con- 
tend with than I had usually encountered, I had to draw 
upon other resources to enable me to overcome it. In order 
to make the peach leaf available, it was necessary to devise 
a form which would be retained by the stomach. I accord- 
ingly prepared it as follows : after reducing the tea to a 
fluid extract, I added a sufficient amount of sugar to make 
a syrup; to this I added sup. carb. soda until it became 
slightly alkaline, and piperin enough to give it a pleasant 
pungent taste. I also added some of the oil of sassafras, 
for the purpose of preventing gangrene of the bowels, 
which I believed to be imminently threatened. 

I have long used the sassafras as an antiseptic, and be- 
lieve it superior to any other known. I learned this 
property of the sassafras more than twenty years ago, 
while living in McConnelsville, on the Muskingum river, in 
Ohio : there being many salt works in the vicinity, which 
gave employment to several hundred hands, many of whom 
were dissipated and reckless, shocking bad scalds were of 
frequent occurrence, by having an arm or a leg immersed 
in the boiling brine ; dangerous sloughing was often the 
consequence. 

In the management of these cases, I found the sassafras 
poultice more effectual in arresting gangrene and restoring 
vitality to the parts than any other means, and have used 
it ever since in all cases of gangrene coining under my 
treatment, with the most happy effect. I also used it, and 
found it a valuable means of fulfilling several other indica- 



DYSENTERIC FEVER. 171 

tions, one of which is to prevent narcotic stimulants from 
producing injurious effects upon the brain. It is invaluable 
for this purpose ; its greatest power is exerted over hyos- 
cyamus and tobacco. 

I found the above compound to answer my purpose finely. 
It was not only well retained, but quieted the irritation, 
both of the stomach and bowels ; brought about a more 
uniform temperature ; dried up the cold sweat when present ; 
in short, answered every purpose for which it was com- 
pounded. I kept the abdomen, most of the time, enveloped 
in a peach leaf poultice, and gave injections of the tea, 
thickened with flour, to which I added pulverized opium in 
preference to laudanum : I found it less stimulating and 
more astringent. 

I have long been in the habit of exposing a piece of opium 
to the air to dry, on purpose to be used in the bowel com- 
plaints of children. It is much less offensive to the stomach 
than the moist article, and is less narcotic and more as- 
tringent. It of course must be given in greater quantity. 
This injection usually gave the patient three or four hours 
rest from the tearing discharges, much to his comfort and 
advantage. 

I occasionally, however, met with a case in which the 
irritability of the bowel was so great, and its involuntary 
contraction so strong, that mechanical assistance had to be 
rendered to enable the patient to retain the injection. This 
was afforded by making firm pressure upon the hip. After 
the lapse of ten or fifteen minutes, the bowel usually ceased 
to make any expulsive effort, and the pressure was then 
withdrawn. I have also met with cases the very reverse 
of the above. There was no tenesmus, no pain attending 
the discharges, which were tolerably copious, and composed 
of red jelly, having no foetid smell, but a peculiar odor, 
something like that arising from water in which fresh 
meat has been washed, and were voided almost involun- 
tarily. 

On examination, I found the sphincter so relaxed as to 
bring several inches of the bowel within view, which pre- 
sented the appearance of raw macerated beef. In these the 



172 on fever: 

surface was always more or less cold, and covered with a 
dewy perspiration ; great thirst and precordial uneasiness. 
I treated these cases by throwing up cold sugar of lead 
water into the bowel, and repeating it every few minutes, 
until I saw some contraction take place ; then gave a small 
injection as above, and made it stay by pressure. I found 
it best to make my injections very small, not over half a 
gill. This quantity would be retained without difficulty, 
when a larger, owing to the stimulus of distention, could 
not be made to stay a moment. 

By the first of August the disease had disappeared in my 
practice, but still prevailed south and east. In the neigh- 
borhood of Lancaster, and east of the Caney Fork, extend- 
ing into a part of Jackson county, the disease was attended 
with unusual mortality. At the solicitation of a Mr. Owens 
of our neighborhood, I visited his son's family, east of the 
Caney Fork, and found all of them very sick, except him- 
self. After prescribing for them and a few others in the 
same vicinity, I went to Lancaster to see my friend, Dr. 
Rose, who I learned was prostrated with this disease. 

Here I met with Dr. Sypert, who lived a few miles dis- 
tant, both of whom strongly solicited me to remain, and try 
to stay the destruction of human life, which was then pro- 
gressing at a fearful pace. More than a hundred deaths 
had been reported as taking place within an area of ten or 
fifteen miles square in a few weeks. 

As there was no sickness of any kind in my neighbor- 
hood, I consented to stay, and for about six weeks was un- 
remittingly employed in visiting the sick, except while pay- 
ing a few hasty visits to my family. 

Some perhaps may be ready to surmise that the disease 
had abated in malignity about the time I commenced treat- 
ing it, but that was not so, as was shown by the fact that 
patients continued to die beyond the circle of my practice. 
Only a few days before I left the neighborhood, I was called 
some ten or twelve miles to visit a family, where I found 
one already a corpse, another dying, a third beyond the 
influence of medicine, and died in eight hours, and a fourth 
badly attacked, who recovered. This family had been 



DYSENTERIC FEVER. 173 

attended by two intelligent physicians, who, as far as I 
could learn, had skilfully administered the usual remedies. 
Dr. Sypert adopted my method of treatment, and was 
equally successful with myself. Dr. Rose, unfortunately, 
never regained his health sufficiently to resume the practice, 
until the disease had subsided. I hereby acknowledge the 
obligation I am under to*both of these physicians, for their 
gentlemanly bearing toward me while practicing in their 
vicinity. It was greatly owing to their influence that I 
obtained access to so large a practice. 

While in the neighborhood of Lancaster, I prescribed for 
more than one hundred and fifty cases of dysentery, many 
of which were attacks of that disease in its worst forms, 
and yet but two of my patients died, both of which cases 
I think were rendered fatal by other causes. One was a 
colored boy living with Wm. Lancaster, about seven years 
old; had had the whooping-cough very badly for ten or 
twelve days before taking the flux ; found him also full of 
worms — -more than twenty large ones were expelled, and 
their expulsion produced so much prostration that he was 
unable to cough efficiently, and died of engorgement of 
the lungs ; the flux seemed to have but little agency in his 
death. 

The other case is remarkable as showing the power of the 
imagination in determining the issue of a disease. The 
patient, Miss White, of perhaps thirty years of age, had 
suffered under a complication of female diseases many years, 
among which dyspmenorrhoea was prominent. Her mother 
had died a few days before I was called to the family ; three 
others were simultaneously attacked. I mention these facts 
in order to show that causes existed calculated to produce 
a high state of mental excitement. On the second night 
after the three had been taken sick, she dreamed that she 
also took the disease, and died on the sixth day. Before 
night she had the usual symptoms, and was so fully im- 
pressed with the belief that the disease would terminate 
according to her dream, that it was with difficulty I could 
induce her to submit to treatment; in fact, it was only in 
my presence that she did. I arrested the disease several 



174 on fever: 

times, but found her as Ibad as ever on the next visit. And, 
true to her belief, she died at the precise time she had 
dreamed. 

Before going further into an exposition of my method of 
treatment in dysentery, I think best to make a few observa- 
tions on its cause and nature. Every physician to some 
extent conforms his treatment to his theory, and thus errors 
in theory beget errors in practice, which I believe has been 
the case to a most lamentable extent with respect to the 
disease under consideration. Before, however, undertaking 
to show what I believe to be its true cause and nature, I 
will try to remove some mischievous errors upon the sub- 
ject, the most important of which I consider the opinion 
that it is of miasmatic origin, and, of course, must be treated 
as a mere modification of bilious fever. Hence the free 
exhibition of calomel and quinine, which I am forced to 
believe have aided the flux in sending more persons prema- 
turely to their final reckoning than would at all comport 
with the honor of the profession to be fully known. 

For a few years past, this disease has been the source of a 
greater outlet of human life in the United States than perhaps 
any other ; which, I think, ought not to have been the case, 
and consider it highly important that the medical profession 
should look into this matter, and see if there has not been 
a needless amount of mortality. That dysentery has not a 
common origin with bilious fevers, I infer from the follow- 
ing considerations : 

First. It does not necessarily originate under the same 
circumstances, or in the same localities. I am aware that I 
have come in conflict with a host of very high authorities, 
backed by an array of seeming facts, which I cannot now 
undertake to investigate, but will honestly and fairly state 
what I have seen and observed upon the subject, on which 
my own opinions have been founded, and leave it for others, 
more competent, to investigate the whole ground. 

If I can only be the instrument of eliciting a thorough 
review of the subject, I shall have accomplished much. I 
reiterate the assertion, that flux does not necessarily origi- 
nate under the same circumstances or in the same localities 



DYSENTERIC FEVER. 175 

with bilious fevers ; that it often does, I admit ; and that it 
is often complicated with them, I also admit ; which I pre- 
sume has been the foundation of the mistake with regard to 
theii being of the same family. 

Large and densely populated cities are known to be 
almost exempt from miasmatic fevers. Can this be said 
with regard to dysentery ? I think not. In many locali- 
ties, which are annually visited by miasmatic fevers, dysen- 
tery only appears occasionally, and in others not at all. 
Poor, elevated situations, such as the barrens of Warren, 
White, and Jackson counties, where bilious fevers have 
hardly ever been seen, are as subject to dysentery as the 
Mississippi bottom. During the two past years these 
counties have been severely scourged. 

Second. Dysentery has a different manner of spreading 
from miasmatic fevers. The latter attack individuals over 
the whole extent of a malarious district, pretty much simul- 
taneously ; but dysentery usually commences at a point, 
and radiates more or less extensively — often stops within 
very narrow limits, often spreads in one or two directions, 
leaving intermediate neighborhoods, similarly circumstanced 
with regard to the production of malaria, and equally subject 
to malarious diseases, entirely untouched. 

I had an unusually favorable opportunity of observing 
the manner in which the disease extended itself in the 
Caney Fork country the present season. The ridge runs 
for many miles almost parallel with the river, at a distance 
of about eight or ten miles ; hollows put out from the river, 
and run almost directly to the ridge, divided from each 
other by high sharp spurs, making off from the main ridges, 
thus forming very marked natural boundaries to each neigh- 
borhood. In order to be better understood in what I shall 
say upon this subject, I will name the several hollows as 
they are familiarly known in the vicinity. The lowest one 
on the river, which I shall mention in this connection, is 
Dillard Hollow ; branching off from the same mouth, is 
Beller Hollow ; about a mile above, is Smith's Hollow ; and 
something like the same distance above this, is Fitch 
Hollow ; two miles farther up, we find Rock Spring Branch \ 
12 



] 76 ON FEVER : 

and three miles above that again, we find Wolf Creek, 
which is as high as my observation extended. I will premise 
here, that the flux commenced on the west side of the river, 
where the country is not so well defined by natural bounda- 
ries, and where its manner of spreading could not be so well 
designated ; but it soon crossed the river at several points, 
and we will commence by noting its progress after crossing 
opposite the mouth of Dillard Hollow. It took up this 
branch, attacking a few families living in the very lowest 
situations, but as it ascended, it spread up into the side 
hollows, and visited nearly all the poor families that had 
made a lodgment between the hills. It thus continued to 
travel upward until it reached the main ridge, and immedi- 
ately opposite the head of Dillard Hollow. From here a 
detachment took down the ridge westwardly, visiting several 
families, until it reached a break which makes down toward 
what is called Hell Bend, down which it travelled, and 
visited almost every family in the bend. Another detach- 
ment took along the ridge eastwardly several miles, and 
sent off a force down a break, making into Snow Creek, 
along which I learned it travelled to its mouth ; but the 
main body seemed to keep along the ridge about a mile 
farther, where it turned down a break into Smith's Hollow, 
attacking nearly every family, and more than half the indi- 
viduals living in it. Now, Beller Hollow lies between this 
and Dillard Hollow, and is an almost exact counterpart of 
them, and yet it remained entirely untouched throughout. 
About the time it crossed the river into Dillard Hollow, it 
also crossed over and took up Rock Spring Branch, passing 
by Fitch Hollow, in which there never occurred a single 
case, except two families living immediately on the river ; 
but it travelled up Bock Spring Branch to its head, not 
escaping a single family, and assailed a family living on the 
ridge directly opposite its termination. From here it spread 
over into Jackson county, beyond the sphere of my obser- 
vations. Near the same time, or a little earlier, it crossed 
over and visited Wolf Creek, again skipping over Indian 
Creek, which remained unmolested many weeks. It assailed 
every family for about four miles, when it suddenly stopped, 



DYSENTERIC FEVER. 177 

i 

and the force diverged ; one part taking up a side hollow to 
the right, and spreading into the flat woods, and the other 
taking up a branch to the left, passing over a gap into 
Buffalo Valley, which communicates with Indian Creek 
about three miles from the mouth of the latter. In Buffalo 
Valley it lingered many weeks, few families, or even indi- 
viduals, escaping; finally it extended down to where it 
communicates with Indian Creek, spreading both up and 
down it throughout its whole extent, with rather more than 
its usual malignity. 

I must here say something more about Buffalo Valley, 
which presents some very striking peculiarities. It is 
about ten miles long, and wide enough to afford many very 
fine farms ; is the only outlet for the water which falls on 
some sixty or eighty square miles, and yet it affords no 
branch, not even a gully can be found, to indicate that 
water ever runs through it, even in the wet seasons. This 
is explained by the fact that the subsoil is composed of 
very coarse gravel, overlaid by a stratum of rich loam and 
gravel, through which water finds its way as fast as it falls, 
and is doubtless conveyed to the river through a subter- 
ranean passage. Now is this a likely locality for generat- 
ing malarious diseases ? I learned that none had ever been 
supposed to originate there, and yet here the flux made one 
of its heaviest sets. I argue, therefore, that it is not of 
miasmatic origin. 

The above is a correct history of the manner of the 
spread of this disease in the above region of country, as I 
observed it myself, and learned from those living in each 
'locality. I will now ask, Is this the usual mode of pro- 
gression observed by malarious fevers ? No one will say 
that it is. The inhabitants of the above country are well 
acquainted with the habits of bilious fevers. They com- 
mence on the river, and extend occasionally some distance 
up the hollows, but never climb the hills, much less ascend 
to the summit of the ridge. Now if flux arises from the 
same cause, how can we account for the fact that notwith- 
standing miasmatic fevers have prevailed along the river 



178 on fever: 

more or less every year, yet a case of dysentery was never 
seen in that country until the past season ? 

It has now been made evident that flux does not neces- 
sarily prevail in the same manner ; and I now say, in the 
third place, it is not ushered in by the same symptoms. 
There is a great similarity in the first stage, or what are 
denominated the premonitory symptoms of all general 
fevers ; such as lassitude, weariness, loss of appetite, dis- 
turbance of the head, aching or soreness of the limbs, etc.; 
few cases are ushered in without being preceded by some 
or all of the above symptoms, which is not the case with 
flux. It most usually has no premonitory symptoms ; the 
first indication of the approach of this disease is the disease 
itself, viz. : the peculiar dysenteric discharge. Sometimes 
a little muco-serous discharge precedes it ; but in the great 
majority of cases which have come under my observation, 
the very first intimation of an attack was a muco-sanguine- 
ous or gelato-sanguineous discharge, attended by more or 
less tenesmus, a sense of heat and general uneasiness in the 
lower part of the abdomen, the individual feeling otherwise 
perfectly well; appetite and digestion good as usual; no 
disinclination to muscular exertion; and, unconscious of 
their danger, many continue to eat and work as usual for a 
day or two after the attack; general disturbance of the 
system seldom took place before the second or third day of 
the disease, and, if proper treatment was instituted in time, 
very seldom took place at all, which was the case in an 
attack which I had myself. After partaking of my break- 
fast with usual appetite, I retired, as is my custom, and had 
a natural alvine discharge, without any thing peculiar about 
it whatever ; but in half an hour after, in attending to an- 
other call, I passed a considerable amount of gelato-san- 
guineous matter, entirely unmixed with any of the usual 
contents of the bowels. It was preceded by some slight 
pains in the lower part of the abdomen, and attended with 
tenesmus and burning sensation in the lower bowel. As 
this was the usual mode of attack in the worst cases, I lost 
no time in resorting to my usual remedies ; refused to ride 



DYSENTERIC FEVER. 179 

until in the latter part of the day, when, finding but little 
uneasiness, I commenced my circuit again, and felt no more of 
the disease, except some uneasiness in the lower part of the 
abdomen, which continued several days. Many other cases, 
could be given similar to this, which served to convince me 
that the flux is purely a local disease at its commencement, 
and that the fever which follows is entirely secondary. 
But with regard to premonitory symptoms, it is true that 
some cases are preceded by more or less indisposition ; but 
as I could discover no regularity or similarity in such cases, 
I was led to look upon them as purely accidental, and not 
necessarily connected with the subsequent attack. I saw 
a few cases preceded by the common symptoms of bilious 
fever, and several were evidently complicated with enteric 
fever. But dysentery is not only not ushered in by the 
usual symptoms which constitute the first stage of mias- 
matic fevers, but, in the fourth place, does not primarily 
or usually affect the same organs. For example, the liver 
and spleen seem to bear the onus of attack in bilious fever ; 
in flux they are seldom involved, and never, I believe, 
except when complicated with the former disease. No 
physician would risk his reputation by pronouncing a case 
an attack of bilious fever, in which there was no derange- 
ment in the functions of the liver; the universality of 
hepatic derangement in miasmatic diseases has given the 
great emulgent, calomel, such a world-wide reputation in 
their treatment ; and a natural bilious discharge is as confi- 
dently expected to be followed by an improvement in these 
diseases, as an effect is expected to follow its cause. But 
in flux, the liver usually performs its office as in health, 
and a natural bilious discharge, so far from affording relief, 
invariably aggravates the symptoms. So uniformly has 
this been the case in every instance coming under my ob- 
servation, that had it not been necessary for the general 
health of the patient that the liver should continue its ac- 
customed action, I would have wished its secretions sus- 
pended during the continuance of the flux. This satisfac- 
torily accounts for the pernicious effects of calomel in the 
disease. We all know the griping quality of what are 



180 on fever: 

called calomel discharges ; they often give much torture 
in passing through the bowels in a healthy condition ; how 
could we, therefore, expect any thing less than insupportable 
tormina to be the consequence of their passage over the 
abraded and inflamed mucous surface in dysentery, and a 
consequent aggravation of all the morbid associations which 
have been set up in other organs ? 

The nervous system often suffers an amount of prostra- 
tion from this kind of over-stimulation, such as to lead the 
administrator to conjure up a congestive chill, and to con- 
tinue the drama by the administration of quinine, until its 
finale is made tragical indeed. 

I have said that the spleen is another organ which prin- 
cipally suffers in miasmatic fevers ; hence the efficacy of 
quinine in this treatment, which it is now ascertained acts 
specifically upon that organ ; but it also acts powerfully 
upon the brain and great nervous centres, perhaps by direct 
stimulation through the medium of the circulation, produc- 
ing a most happy effect in the depressed stages of mias- 
matic fevers, but a most disastrous one in the depression 
occasioned by excessive irritation in dysentery. 

Another organ primarily affected in miasmatic fevers is 
the stomach : loss of appetite, loathing of food, nausea, 
etc., are among the best diagnostic symptoms of an attack, 
which is not the case in flux. The stomach is rarely at all 
affected at the commencement of this disease; food is taken 
with as good a relish as usual, and digestion is performed 
as well as common. It is only after the local disorder has 
continued with a sufficient intensity long enough to get up 
spinal irritation, that the stomach becomes involved, after 
which it often suffers severely. 

Recapitulation : — Dysentery does not necessarily prevail 
under the same circumstances or in the same localities with 
miasmatic fevers ; has a different mode of progression ; is 
not ushered in by the same symptoms ; does not primarily 
or necessarily affect the same organs, and is not relieved by 
the same remedies ; which reasons appear to me sufficiently 
conclusive that they have not a common cause. Others 
have supposed dysentery to be the effect of atmospheric 



DYSENTERIC FEVER. 181 

vicissitudes ; but that any agency operating so universally 
and continually as these should be the cause of a disease 
appearing only occasionally and within limited boundaries, 
appears to me to be very improbable. Neither do I believe 
it to be contagious in any proper sense of that term. I 
never could trace it from individual to individual. Those 
who visited the sick did not seem to be more subject to an 
attack than others who did not. It visited families that 
lived remote from any others, and it often attacked those 
members of a family first who had never been from home. 

The inhabitants of the two hollows mentioned above, 
which escaped the disease to my certain knowledge, fre- 
quently visited the adjoining affected districts. The only 
theory which will at all agree with the history of this 
disease with regard to its erratic mode of appearing and 
extending itself is, that it is caused by the poisonous influ- 
ence of a species of animalcule, whose habitudes lead them 
to make a lodgment in the mucous membrane of the lower 
bowel, which is selected by them as a suitable nidus into 
which they can burrow and hatch another brood. 

It is now believed, if it has not been positively proven, 
that cholera is caused by an insect ; and there are many 
points of resemblance between it and dysentery, both 
with regard to their manner of spreading, mode of attack, 
and the manner in which they affect the system. They 
differ, however, in the part of the alimentary canal in which 
the onset is made ; the cholera choosing the stomach and 
upper bowels, and the flux the lower bowel alone. These 
and some other dissimilarities are the result of the different 
instincts or habitudes of different species of animalculse. 

It was when on Caney Fork, contending with the flux, 
and observing its manner of spreading and mode of attack, 
that I first conceived the idea of its being of animalcular 
origin : since which time I discover I was anticipated, this 
opinion having been formed and expressed by others. 

No one viewing the disease under the circumstances 
which I did could resist the above conclusion, after once 
turning his thoughts in that direction. Its wayward and 
whimsical mode of progression is consistent alone with the 



182 on fever: 

fickleness of insect migration. The most prominent cha- 
racteristics of the disease are perfectly consistent with this 
theory, and may he beautifully explained in unison with it. 
The first discoverable symptom is that which might arise 
from the stimulation produced by the titillation of the 
mucous membrane by the little intruders on first taking 
possession of the part, viz.: an increase of the natural 
secretion; but presently they make an entry into the sub- 
stance of the membrane, destroying its texture and ex- 
posing the open mouths of the capillaries, irritate the 
nervous extremities with which the part is so abundantly 
supplied, and, of course, get up a state of high morbid 
excitement— the result of all which is general uneasiness 
of the parts, discharge of mucus mixed with the blood 
exuding from the exposed capillaries, and a constant feeling 
as if something was wanted to be expelled, with spasmodic 
efforts of the bowel in making these expulsive efforts, etc. 
This continual teasing and irritation of the sentient nervous 
extremities, finally convey sufficient morbid impression to 
the spinal column to get up morbid excitement in it and 
the other great nervous centres, which is soon conveyed by 
the nerves to every part of the organic structure, and 
general disease is the consequence ; each organ and tissue 
complaining according to its peculiar mode : the brain by 
disturbance of ideas, giddiness, vertigo, stupor, etc. ; the 
stomach by burning, nausea, vomitingj etc. ; the kidneys by 
increased, depraved, or suspended secretions ; the skin by 
constriction, dryness, morbid exhalation, etc.; and the 
whole system by a sense of ill-being. This state of things 
continues until the enemy is either destroyed, expelled, or 
has gone through its period of incubation, and is expelled 
with the mucous membrane : provided, however, that the 
patient should escape gangrene, or the system should not 
sink under the pressure of so much morbid action, before 
the disease has run its course. 

That flux is not merely ordinary inflammation of the 
mucous coat of the lower bowel, I infer from the fact that 
the common symptoms of inflammation are not sufficiently 
prominent ; they are rather those of irritation, and are not 



DYSENTERIC FEVER. 183 

relieved by the means which usually subdue common inflam- 
mation. An abstraction of an equal amount of blood, com- 
monly discharged in dysentery, from the capillaries of an 
inflamed surface, would, of itself, arrest any ordinary 
inflammation. Blisters, which exert such a powerful con- 
trol over inflammation, are without benefit, if they are not 
positively injurious, in this disease. It is therefore evident 
that the disease of the bowel in flux is of a specific nature, 
gotten up by the agency of a specific cause ; and that that 
cause is the presence of poisonous animalcule, is rendered 
still more probable, from the fact that those means which 
are known to be destructive to insect life are most effectual 
in arresting this disease. / 

This is eminently true with regard to the sassafras. I have 
experimented pretty fully with this article with reference 
to this subject, and have found it to be immediately fatal to 
all insects to which I have had an opportunity of applying 
it. It is perfectly amusing to witness its application to a 
woolly puppy, or a little negro's head. It will clear them 
of inhabitants in less time than I can tell it. A little 
applied to my own person has often made an army of heel- 
bugs retreat more precipitately than Bragg's battery ever 
did the Mexicans. 

During the winter I have carefully examined every 
author within my reach, and have overhauled old files of 
medical journals, and have found that the operation of every 
remedy which I can find to have been used with any con- 
siderable degree of success in dysentery, may be rationally 
explained in view of the above theory. They all seem to 
perform their beneficial effect in one of the three following 
ways : either by destroying the animalculse, expelling them 
mechanically, or by counteracting their injurious effects, 
enabling the system to sustain the injury until they run 
their race. 

The most efficient means which has hitherto been gene- 
rally used, calculated to fulfil the first indication, that is, 
to destroy the animalculse, is spirits of turpentine. Many 
physicians have tested its beneficial operation in flux. But 
its use is attended by a very serious objection. Every 



184 on fever: 

practitioner who has had much experience in this disease, 
has observed that dj^suria is a very common and trouble 
some attendant, owing to the close sympathy existing 
between the lower bowel and the kidneys and bladder. 
The use of turpentine serves to aggravate this difficulty, 
and mairy cases of permanent injury to the kidneys have 
come under my observation occasioned by its use, both in 
flux and typhoid fever. As this has become a very fashion- 
able remedy, it would be well for the profession to look a 
little closer to the result of its improper exhibition. I have 
had unpleasant effects produced even by its external appli- 
cation, both on the kidneys and stomach, and was led to 
devise some means\of avoiding the difficulty without giving 
up the use of so valuable a curative means, and succeeded 
by combining it with nearly an equal quantity of ammonia. 
In this form it is not absorbed, and its efficacy as a topical 
application is very much increased. If any one still doubts 
cuticular absorption, let him try the experiment of making 
friction on some part of his person with a flannel cloth, 
saturated with warm turpentine, and if he fails to detect 
the violet odor on his urine, it will be because he has a had 
cold. 

The peach tree and sassafras are not only more effectual 
than the turpentine in destroying the animalculae, but are 
less offensive to the stomach, and, in place of increasing 
dysuria, operate as a preventive. None happened in my 
practice. 

Another article which has been much relied on in private 
practice, and is favorably mentioned by several authors, is 
sulphur, which, no doubt, owes what advantage it possesses 
in the cure of flux to its property of destroying insects. 
The same is true of camphor, and some other articles of 
less note. The second indication, that is, to expel the 
enemy per force, is often accomplished by active purga- 
tion. 

Many of our best writers agree as to its advantage, but 
differ widely in the use of the means employed. The 
objection to the use of drastic purgatives in this disease is, 
that if they fail in expelling the enemy, they do not fail in 



DYSENTERIC FEVER. 185 

lessening the powers of the system to bear up under its 
subsequent depredations. 

The third indication, that of enabling the system to sus- 
tain the injury until the disease runs its course, will include 
much the largest class of means which have been used with 
advantage in this disease ; prominent among them are the 
different preparations of opium, which act beneficially by 
lessening the irritation in the bowels, subduing the excessive 
general nervous irritability, and breaking up morbid associ- 
ations. Next in efficiency to opium are poultices and 
fomentations, which serve to equalize temperature, and 
appease the over-excited nervous extremities. An occa- 
sional mild purgative is also beneficial, by preventing any 
accumulation of offending matter in the upper bowels. 
Many other means have been resorted to, with more or less 
advantage in fulfilling this indication, but I shall not pur- 
sue the subject farther, but will now give my own method 
of treatment in a condensed and connected form, so as to be 
better comprehended. 

And first, I will give my manner of preparing what I call 
compound syrup of peach leaf. I take as many peach leaves 
as will fil] a ten-gallon kettle, and weight them to prevent 
their rising, and add water until they are covered, bring it 
to a boiling heat, and keep it at a simmer for two hours ; 
take out the leaves ; strain and settle the infusion ; then 
evaporate by a moderate heat, until it begins to thicken ; 
there will now be about one quart ; to this I add five 
pounds of sugar, and, when it is melted, sup. carb. of soda 
until it ceases to effervesce ; then add one drachm of piper- 
in, finely powdered, and one ounce of oil of sassafras ; after 
stirring them together effectually, and the syrup has con- 
siderably cooled, I then acid half a pint of brandy. I have 
usually made use of a good article of American brandy for 
this purpose. Of this syrup I give a tablespoonful every 
hour, until the disease yields. If it produces any unplea- 
sant excitement, I lessen the dose, and always discontinue 
it during sleep. With regard to injections, what I have 
said in the first part of this paper is sufficiently specific, 
and will not be repeated. In most cases, by adding a little 



186 on fever: 

morphine to the syrup, a necessity for the use of injections 
is superseded; the abdomen should, most of the time, be 
enveloped in a peach leaf poultice, or flannel saturated with 
the infusion. It is generally necessary once in twenty-four 
hours to administer a mild purgative, in order to obtain a 
fecal discharge. I prefer epsom salts to any other for this 
purpose. 

Occasional symptoms must of course be combated by 
such appropriate remedies as the judgment of the practi- 
tioner may decide to be indicated in each case. 

I have not found it necessary to be very strict with 
regard to diet ; in most cases the powers of the stomach are 
but little crippled, and notwithstanding there may be con- 
siderable nervous irritability of that organ, yet it generally 
performs its office of digestion very well, and I found it 
best to give it employment. I consequently allow mild 
digestible food to be taken quite freely ; even a small piece 
of fried chicken has often been allowed, much to the gratifi- 
cation of the patient, by removing the nausea, and appeasing 
the craving of the stomach. No unpleasant consequence 
ever followed the indulgence. Other physicians often 
attributed the death of their patients to some improper in- 
dulgence in food. Fatal relapses were often said to be pro- 
duced by this cause, and perhaps justly. But I had no 
relapses, and allowed my patients great latitude in eating. 
My course of treatment, by sustaining the tone of the 
stomach and preserving the general strength of the system, 
prevented any considerable debility ensuing, and, conse- 
quently, convalescence was neither tedious nor precarious. 
I will here give a list of a hundred cases, taken in connec- 
tion from my day-book, showing the time each patient 
required my attendance. Many were visited for a day or 
two after convalescence, and all were directed to continue 
the remedies for some days after decided convalescence, in 
order to insure its stability. The time embraced in the 
following list is that in which the patient was sick enough 
to require being visited. The protracted cases were all 
complicated with other diseases : 



DYSENTERIC 


FEVER. 


29 cases were 


visited only 1 day. 


37 




" 2 days. 


14 




66 3 66 


7 




66 ^ 66 


9 




6 " 


3 




66 9 66 


1 




66 12 " 



187 



One chief cause why so few visits were necessary in the 
above cases, may be found in the manner in which I con- 
ducted my visits : my habit was, when called to a new 
case, if it was a bad one, to tarry with my patient until I 
had arrested or materially controlled the disease, even if it 
required several hours' detention ; then, by leaving full and 
specific directions, the case was often managed without 
another call. In this way I was enabled to attend to many 
more cases than I possibly could have done by paying flying 
visits, and repeating them daily. 

And though this kind of slow movement often kept new 
calls waiting until patience was well-nigh exhausted, yet I 
found that they only had to suffer a few additional hours, 
as the disease, when once fully formed, usually became no 
harder to manage for several days. 

Since the above period, I have kept myself posted as to 
the prevalence of dysentery in that region of country, and 
I find that a few scattering cases have occurred every sum- 
mer, within the boundary of its former ravages ; but that 
every year it has prevailed epidemically, beginning at one 
or more points near the margin of the space over which it 
had travelled the previous season. During the early part 
of the present summer it prevailed over a considerable space 
of country, commencing some miles west of the Caney Fork, 
and extending in the direction of Nashville. But few 
escaped an attack, and, as it was attended by physicians 
who obstinately adhered to the use of calomel treatment, 
the mortality was fearful : over twenty deaths occurred in 
two families. This disposition of epidemic dysentery to 
commence one season at a point near which it had stopped 
the previous year, has been observed and spoken of by 



188 on fever: 

others ; several instances are given in reports on epidemics 
in the " Transactions of the American Medical Association ;" 
but as they are not at hand just now, I cannot refer to the 
page. 

I might here close my remarks on dysentery, but think 
best to make a resume, so as to leave the reader's mind dis- 
tinctly impressed by the most important points, especially 
in the treatment. It is much to be lamented that there is 
still no improvement in the management of this disease 
throughout the United States ; the yearly bills of mortality 
show this to be so ; and physicians generally have not yet 
learned that the exhibition of mercurials is very generally 
associated with death in typhoid dysentery. There is still 
no approach to uniformity of treatment, even in recognized 
varieties, except so far as giving mercurials is universal. 

Perhaps no disease is more variously treated in the United 
States than this. This want of uniformity in its manage- 
ment is no doubt partly owing to a want of correct know- 
ledge of the nature of the malady, and partly arises from 
the diversity of character which it assumes in different 
localities and at different times. The particular disease 
known as dysentery, or flux, is undoubtedly a local affec- 
tion, consisting in a certain amount of irritation or inflam- 
mation of the mucous lining of the lower bowel ; but this 
local disease cannot exist long or intensely without involv- 
ing the general system, manifested in the form of fever; 
and the fever will take on the particular form or type to 
which the system has been predisposed by atmospheric or 
epidemic influences ; or the fever may have been first set 
up, and the dysenteric symptoms superadded afterward, or 
both may be developed at the same time by the same ex- 
citing cause. Hence, we find flux existing as an independ- 
ent disease, unaccompanied with any fever ; and we find it 
associated with the different grades of miasmatic fever and 
typhoid fever ; and we see it arising in the course of these 
fevers ; and see these fevers developed in the progress of 
independent cases of flux. The only sensible way, there- 
fore, of viewing dysentery, is to first consider it as a dis- 
tinct local disease, and to contemplate the associating fever 



DYSENTERIC FEVER. 189 

also as an independent affection ; and then consider in what 
manner each influences the other. 

Dysentery proper consists of a peculiar kind of irritation 
in the mucous membrane of the lower bowel, exciting a 
more abundant discharge of the natural mucus of the 
bowels, attended with a sense of uneasiness, and more or 
less burning pain and increased contraction of the lower 
bowel, producing a prolonged disposition to remain at stool, 
with more or less tenesmus or straining. As the disease 
advances, the mucus is generally exchanged for jelly mixed 
with blood. All this may take place, and yet the indi- 
vidual continue in nearly usual general health ; having no 
chills, no fever, no loss of appetite ; and, except when 
suffering paroxysms of tenesmus, no feeling of indisposition 
of any kind, showing that the disease is as yet purely 
local. In this form, and in this stage, it is very easily 
managed. For twenty years I have relieved all such cases 
in a short time by simply ordering peach leaf tea and injec- 
tions of starch and laudanum. Any part of the peach tree 
will answer for making the tea, as well as the leaves. In 
the winter I use the twigs. The dose is about a third of 
a teacupful every hour or two ; an injection of half a gill of 
starch or flour gruel, with twenty to forty drops of lauda- 
num, or three or four grains of denarcotized opium, should 
be given after each discharge. If there should not be fecal 
discharges produced by the tea, I give epsom salts or 
seidlitz powders. If there is considerable tenderness of 
the abdomen, I direct a poultice of peach leaves, or, in 
their absence, a tea of the bark or twigs, thickened with 
wheat bran. But if the flux is complicated with fever, 
more than these means, which are all directed to the local 
affection, becomes necessary to be done. The fever must 
be met by such treatment as will control it ; and a reason 
why so great a mortality has attended this disease in many 
parts of the United States, of late years, is doubtless 
because it was complicated with typhoid fever, a disease 
which, under the ordinary treatment, runs a tedious course ; 
a disease which is attended in its progress with ulcerations 
of the upper bowels, which, by concert of action, will keep 



190 on fever: 

up the dysenteric inflammation of the lower bowel, and 
both, combined with the depressing nature of the fever, 
become more than the system can endure, and it sinks 
under it ; and more especially if the depressing influence of 
mercurials is added. Human nature was not designed tc 
bear up under all these, "and it won't." By the aid of my 
plan of aborting typhoid fever, this form of dysentery 
becomes as manageable as any other. All that is necessary 
in the case is, to add a tablespoonful of the comp. syrup of 
valerian to a cup of the peach leaf tea, and give a third of 
it every hour. As the comp. syrup of peach leaf contains 
the essential properties of the fever syrup, it alone will 
control it, or they may be given alternately. In a few 
days the fever will be broken up ; and even should the 
dysenteric symptoms continue a few days longer, the patient 
will steadily improve in general health. But if the fever 
should be of the bilious kind, I still do nothing more, as* 
the same treatment will break that up with equal facility, 
except there should be chills, and then the addition of a 
few grains of quinine will meet that feature. 

The following extracts will show what success has 
attended my plan of treating dysentery in the hands of 
others : 

Dr. J. E. Fulton, Big Oak, Miss., writes : 

" I have had an opportunity of trying your plan of treat- 
ment in dysentery, and in my hands it has come fully up 
to your representations." 

Dr. A. M. Walls, Madison Cross Roads, Ala., says : 

" I have treated a few cases of dysentery with the peach 
leaf tea, etc., in all of which it proved successful." 

Dr. W. Shaparcl, Scottville, Ky., writes : 

" I have used your treatment for dysentery in my prac- 
tice with great success." 

Dr. W. M. Cook, Silver Springs, Tenn., says: 

u I have used your treatment for flux several years, and 
find it just what you represent it." 

Dr. R. Smith, Thebes, 111., says : 

" I am much pleased with the effect of peach leaf tea in 
dysentery." 



CHOLERA INFANTUM, OR SUMMER COMPLAINT. 191 

Dr. John K. Cypert, Monterey, Tenn., writes : 
" I am highly pleased with peach leaf tea in the treat- 
ment of dysentery. I have derived great advantage from 
it, but do not consider it a specific." 

Dr. J. Gr. Boyd, Shady Grove, Tenn., writes : 
" Your plan of treating dysentery has been entirely suc- 
cessful in my hands." 

CHOLERA INFANTUM, OR SUMMER COMFLAINT. 

Children during the second summer often have a hard 
struggle for existence. The food which nature furnishes 
for early life being withheld, or proving inadequate to their 
sustenance, they are forced to depend upon other kinds not 
so readily assimilated ; and not having the teeth or digestive 
powers to manage properly the ordinary diet taken by older 
members of the family, and possessing a higher degree of 
irritability than those of maturer years, the half-digested 
food often acts as a direct irritant to the coats of the bowels, 
causing increased secretion and increased peristaltic motion, 
constituting diarrhoea. Thus the food, instead of being 
appropriated to the nourishment of the system, weakens it 
by acting as an irritant, causing the child, as it decreases in 
strength, to increase in nervous excitability, until some 
exciting cause, as change of temperature, or the irritation 
of a protruding tooth, so impresses the nervous centres as 
to get up general nervous disturbance, which, connected 
with capillary debility, we have seen constitutes the first 
stage of fever. Reaction takes place as in other fevers ; 
and as the stomach and bowels in this case are already in a 
state of morbid excitement, they constitute the weak point, 
and the onus of the disease is thrown upon them. The 
indications to be met in this disease are, therefore, to 
remove the excessive irritability of the stomach and bowels, 
to quiet nervous disturbance, restore capillary action, and 
then improve the tone of the digestive organs so as to 
guard against relapse. 

If the case be taken in time, before fever is set up, the 
treatment is very simple. The diet of the child should be 
restricted to such articles as are most digestible, least irri- 
13 



192 on fever: 

tating, or subject to ferment — such as boiled milk and stale 
bread, rice, sago, etc. To improve digestion and restore 
the tone of the stomach and bowels, I prefer the following 
formula above any I have tried, viz. : good French brandy, 
half a pint ; pulverized cinnamon bark and nutmegs, each, 
two drachms ; piperin, ten grains ; loaf-sugar, a fourth of a 
pound. Dose, one or two teaspoonfuls, combined with four 
times its volume of milk, repeated three times a day, or 
oftener if required ; or it may be added to a cup of boiled 
milk at meals. If the disease be suffered to continue until 
fever is set up, and there is vomiting, swelling and tender- 
ness of the abdomen, etc., I direct a lye poultice to the 
bowels, and a grain of calomel every three or four hours, 
until bilious discharges are obtained, and then commence 
the treatment as before directed. Sometimes, however, the 
fever is truly malarious, and,' besides the above remedies, 
requires a few grains of quinine. 

Sometimes the thirst in this disease is perfectly intole- 
rable ; in which case, though the surface may be cool, we 
may know there is great internal heat. I manage such 
cases by applying a cold wet cloth to the abdomen, renew- 
ing it as it becomes hot; for, notwithstanding the cool 
surface, the cloth will soon absorb the heat from the over- 
charged internal surfaces ; at the same time I administer 
internally a weak solution of epsom salts, given in small 
quantities, and frequently repeated. I usually add some 
sup. carb. soda and a little Dover's powder. My formula 
is, epsom salts, three drachms ; sup. carb. soda, one drachm; 
Dover's powder, twenty grains, dissolved in twelve ounces of 
water, of which I direct a tablespoonful every hour. This 
will be drunk with avidity by the little parched sufferer, 
and should be continued until the vomiting ceases and the 
thirst is partially allayed, even should it appear to increase 
the purging. No other drink, or any thing else, should be 
taken on the stomach until the vomiting subsides. 

The interval should now be extended, and a tablespoonful 
of new cream given between each dose. The cream will 
not coagulate, and is exceedingly soothing to the irritated 
lining of the stomach, and affords the most readily assimi- 



CHOLERA INFANTUM. OR SUMMER COMPLAINT. 193 

lated nutriment that can be selected, which the famishing 
child so much needs. After the patient has become relieved 
by the above means, the anodyne carminative , or brandy 
mixture, the formula of which is given above, should be 
commenced, for the purpose of restoring the vital powers. 
Sometimes the constitutional disturbance attending this 
disease is not sufficient to produce fever ; the child keeps 
up, retains some appetite, though morbid, occasionally 
vomiting, and once, or oftener, in the twenty-four hours, 
has an attack of diarrhoea ; which, from its violence, seems 
as though it should produce speedy prostration, but it stops 
of itself, and the little fellow falls asleep, and presently 
awakes to cry for food. But emaciation goes steadily on, 
the abdomen becomes tumid, the face and hands puff, and, 
if the disease is not arrested, the child must die ere long. 
In these cases I begin with the saline mixture recommended 
above, and regulate the diet as before directed, usually 
giving three or four grains of Hyd. cum Creta [Blue powder] 
every night. This treatment should be continued three or 
four days, when it will usually be safe to commence the 
anodyne carminative. A multitude of poor little shrivelled 
specimens of humanity, whom to wish dead seemed to be 
benevolent, have by this means been restored to perfect 
soundness and plumpness. 

Dr. J. S. Burford, Whiteville, Tenn., writes : 
" I have a beautiful little daughter, now in the enjoyment 
of the most perfect health, who was brought down to the 
verge of the grave by that great baby-destroyer, 6 cholera 
infantum,' upon whom every means were employed without 
avail, until treated according to the plan you recommend. 
It acted 'like a charm.' I. feel that I am indebted to you 
for her life." 

The treatment recommended by authors, both for cholera 
infantum and dysentery, is so diffuse and so unsatisfactory, 
and, it might be added, so contradictory, that it has not 
been thought necessary to trouble the reader with it. The 
most sensible treatment may be found in Wood, to which 
the reader is referred. 



194 on fever: 



CHAPTER VII. 

ERUPTIVE FEVERS 



VARIOLA, OR SMALL-POX. 



Notwithstanding the discovery of Jenner, which justly 
immortalized him, through the inattention of the people 
this dreadful disease almost yearly makes its appearance in 
our large cities, and along the great thoroughfares. Hence 
it becomes necessary that everybody, and especially every 
physician, should be able to recognize the disease, and 
give it the best treatment that the light of the present age 
affords. 

The forming stage of this disease cannot be distinguished 
from that of measles, scarlatina, or, in fact, any other fever ; 
it is only when the eruption begins to appear that it can be 
identified ; and here I will hazard a statement, which will 
run foul of authority — that is, that this disease cannot be 
communicated until after the eruption is pretty well formed. 
Much inquiry and close observation have fully convinced 
me that this is the case ; and by knowing this to be true, 
much alarm and uneasiness may often be prevented. I am 
aware the contrary is true of measles and scarlatina, the 
most contagious period of which is during the preliminary 
fever. If this were so of small-pox, the disease would, 
every time it makes its appearance, spread among all the 
friends and visitors. 

When the eruption does make its appearance, it can be 
immediately recognized by any one who will preserve the 



VARIOLA, OK SMALL-POX. 195 

type in his mind, it being unlike any other. , The first ap- 
pearance is a few very small and exceedingly red points, 
scattered over the breast, and next appearing on the face. 
These points are smaller and of a deeper scarlet red than any 
other eruption for which it could be mistaken. Twenty- 
four hours subsequent you will find the number of points 
increased, sometimes very greatly, and now are more 
numerous on the face : hence, I suppose, the mistake of 
authors that it always begins on the face, the few that first 
appeared upon the breast having been overlooked. By this 
time the first points that made their appearance have begun 
to fill with a clear limpid secretion, and have lost their 
peculiar redness. As these vesicles enlarge, they become 
surrounded by a circle more or less red, according to the 
amount of fever which is present. 

These vesicles soon acquire a slight depression in the 
centre ; but in the course of four or five days they again 
assume the rounded form, owing to the lymph giving place 
to suppuration. They now are much enlarged, and have 
acquired an opaque yellowish appearance. 

In three or four days more, the pustules begin again to 
sink in the centre, and often part of the matter oozes Out, 
yielding an exceedingly unpleasant odor, and so peculiar as 
to be always readily recognized afterward. In five or six 
days more the scabs fall off, leaving deeply discolored spots, 
and often unsightly pits. 

The disease as described above is known as distinct small- 
pox. Sometimes the pustules, particularly on the face, are 
so numerous that they run together, making large con- 
tinuous patches ; this is known as confluent small-pox. 
Then, again, the pustules may merely touch without run- 
ning together, which is called semi-confluent. 

The stages of this disease are nearly as follows : Period 
of incubation, or time between receiving the contagion and 
accession of fever, twelve days ; period of fever before the 
eruption appears, three days ; pustular stage, four days ; 
drying stage, four to six days. This is true with regard 
to the eruption on the face and breast ; that upon the body 



196 ON FEVER : 

and extremities, by appearing later, will also be behind in 
all the stages. 

From the time that the fever commences until the erup- 
tion is fairly out, the patient is commonly quite sick ; com- 
plains of headache, nausea, pains in the bones, considerable 
fever, etc.; but when the eruption is fairly out, all these 
symptoms generally give way very suddenly, and the 
patient complains but little, except of the surface, until the 
suppurative stage commences ; secondary fever is now set 
up, which often runs very high, and in confluent small-pox 
often causes death. 

Treatment.- — The treatment of small-pox was once per- 
fectly murderous — giving hot teas and stews, keeping the 
patient shut up in a close room, and forbidding water. 

This same treatment is yet followed by some of the 
ignorant pretenders to whom the management of this dis- 
ease is sometimes committed. At the present time the 
received practice is palliative ; viz., in the first stage, while 
there is much fever, cooling drinks and very light nourish- 
ment, with occasional spongings of the surface with tepid 
water, and keeping the bowels gently open with seidlitz, 
or a little epsom salts or cream of tartar, and a few grains 
of Dover's powder at bedtime, to allay restlessness and 
procure sleep. 

When the pustules commence maturating, if the fever is 
of rather a low type, and the pustules fill tardily, nourish- 
ing soups and wine should be given. At every stage of 
the eruption the patient should be anointed with olive oil 
at least once a day ; and when the matter commences oozing 
from the pustules, the surface should be thoroughly cleansed 
with soapsuds, and then oiled. This treatment is generally 
successful ; still, deaths are not unfrequent, and deformity 
by pitting quite common. 

Since adopting my present plan of treating fever, I had 
rather desired an opportunity of testing it in small-pox. 
My opinion was that it would prevent secondary fever, and, 
by maintaining a vigorous condition of the capillaries, pre- 
vent the destructive ulceration of the true skin, which 
occasions the pitting. 



VARIOLA, OR SMALL-POX. 197 

Last winter my desires were gratified. I was called to 
treat four cases of genuine variola, and a number of cases 
of varioloid. I felt so confident that I would prevent pits, 
that I assured the friends that I would do it, if they would 
attend to my directions. During the vesicular stage I gave 
my fever syrup in teaspoonful doses every two hours ; 
allowed plenty of cold water, with cream of tartar suffi- 
cient to render it pleasantly sour; sponged the surface 
when hot, and oiled it when they complained of itching. In 
a few days all constitutional disturbance subsided, and my 
patients sat up, were cheerful, and had good appetite, which 
was rather liberally indulged. When the pustular stage 
set in, I ordered the syrup to be given in half-tablespoonful 
doses, and had the surface well washed with tepid soapsuds 
every day, and then oiled. No secondary fever occurred, 
and hardly any inflammatory action ; so that the areola was 
quite indistinct, the pustules, when in their full rounded 
stage, looking like little balls of cotton sticking on a sound 
surface ; and, as I expected, when the scabs scaled off, 
there was not a mark left, except three on one little fellow's 
forehead, who repeatedly rubbed off the scabs. 

Now these cases were not naturally milder than common. 
A negro man who contracted the disease at the same time 
and from the same person, and who was not considered 
worse than my cases, was treated by another physician, 
and died with secondary fever. One of my cases was 
partly confluent ; the pustules over all the face and breast 
slightly touched each other, and in several places on the 
face ran together, making patches as large as a twenty-five 
cent piece ; and yet, when these scaled off, it was perceived 
that the true skin had not sustained the slightest injury. 

I visited the family (Mr. Edmunds', of the lower suburbs 
of Nashville) about a month since, and found all the chil- 
dren as clear of evidence of having had small-pox as they 
were before having it, except the little fellow who rubbed 
his forehead, and who presented three slight irregular marks 
not at all characteristic of variola. 



198 on fever: 



VACCINE DISEASES. 

No discovery that has ever been made in the world has 
contributed so much to the lessening of human suffering 
and to staying the destruction of human life as that made 
by Dr. Jenner, by which small-pox can be prevented. 
No one can at all appreciate the immense blessing which 
his discovery has conferred upon the world without read- 
ing the history of the fearful ravages which were formerly 
occasioned by small-pox. Now, although the disease occa- 
sionally breaks out in our thoroughfares, and perhaps, 
owing to the carelessness of the people in having them- 
selves fully protected, will always be the case, yet it can 
always be speedily arrested, so as to have but few vic- 
tims. The great difficulty is that persons often suppose 
themselves to be protected when they are not. It is gen- 
erally supposed that what is called a good mark is evi- 
dence of protection, but this is not the case; the local 
disease may run through a regular course, and leave as 
fine a mark as is ever seen, and yet the constitution 
not have been influenced by it at all, and no protection 
secured. Then, again, all the constitutional symptoms 
may supervene, and yet the susceptibility to small-pox 
not be wholly destroyed, and the person may have the 
disease in a modified form, known as varioloid, and may 
communicate the disease in its full form to the unpro- 
tected. Full security can only be obtained by repeating 
the vaccination, at intervals, until what is known to be 
genuine matter will have no effect. 

As I know, from repeated observations, that the most 
perfect mark is no certain evidence of protection, and that 
persons may have what is called a had mark and yet be 
fully protected, I shall not trouble the reader with those 
nice distinctions which we find in the books, and are 
of so little account in practice, but would insist upon 
revaccination until genuine vaccine virus will have no 
effect. 

The virus is the most active when taken in the fluid 
state and immediately inserted. The proper time to 



VACCINE DISEASE. 199 

obtain it is when the pustule has pitted in the middle, 
and the matter is still fluid around the margin. 

My mode of procedure is as follows: I take a warm 
wet cloth and rub the outer side of the left arm about 
half-way between the shoulder and the elbow, continuing 
the friction until the skin is slightly reddened, then wipe 
it dry. I now take some of the fluid matter on the point 
of a lancet, and spread a little on the skin in three places, 
about an inch apart; then scratch very slightly with the 
point of the lancet, first on one place, then on another, 
and continue this alternately until I obtain a very little 
blood from each. Now let the part remain naked until it 
is dry. Some practitioners cover the part with adhesive 
plaster, but this, by causing exhalation from the surface, 
will often draw out the virus and prevent its absorption; 
it is best left without any covering until the pustule is 
pretty well, formed, then it is good practice to cover it 
with isinglass sticking-plaster, to prevent the pustule be- 
ing broken by scratching or the rubbing of the clothes. 

The natural course of the disease is that for a day or 
two after the operation the part is a little inflamed, as it 
would be from the same amount of scratching from any 
other cause. It then gets well, and for four or five days 
shows no signs of soreness whatever, so that persons un- 
acquainted with the subject will imagine that the opera- 
tion has proved to be an entire failure; but about the 
sixth day some constitutional disturbance should come on, 
such as attends the forming stage of most fevers, as sore- 
ness of the muscles, aching of the bones, restlessness, 
perhaps headache, lassitude, etc., followed by reaction and 
febrile excitement, more or less marked, which continues 
for from one to three days. The points at which the 
virus was introduced now begin to itch, redden, feel hot, 
and more or less hard and swollen. Presently a clear, 
watery vesicle is formed, the surrounding inflammation 
becomes extended, sometimes involving the whole arm, 
and requiring some treatment to allay it. The best means 
for this purpose is to envelop the arm with a cloth satu- 
rated with lukewarm water or lead water, and kept wet 



200 on fever: 

by occasionally applying over it another wet cloth, or by 
pouring the water on the arm while held over a vessel to 
catch the dripping. At the same time the following mix- 
ture may be given internally: Put a heaping teaspoonful 
of epsom salts and about half as much common soda into 
a pint of water, and give a wine-glass full every two or 
three hours. If there is much restlessness add ten grains 
of Dover's powder to the above mixture, or give a tea- 
spoonful of paregoric or Bateman's drops with each dose 
of the mixture. Great care should be taken to avoid get- 
ting the vesicle broken while in the fluid state, as that 
will often entirely destroy the protecting power of the 
vaccination, as it is the absorption of the virus from the 
pustule, and thus conveying it into the blood, which gives 
security. Hence the advantage of inserting the virus into 
several points, for all will not be as likely to become rup- 
tured as would one. Then, absorption from three points 
will be much more likely to take place than from one 
only, and the chances of full protection be many times 
more probable. 

There is a very general opinion that the protecting 
power of the vaccine disease wears out by time, thus 
making it necessary to revaccinate every few years. But 
I am certain that this is not the case, but that if a person 
be once protected he will remain so during life. My own 
experience is in point. When a small boy I was vacci- 
nated, and it took thoroughly, causing high fever, and ex- 
tensive inflammation of the arm, and several pustules 
appeared about an inch from the one immediately at the 
point of the insertion of the virus. I have had the mat- 
ter frequently inserted since that time, but no effect has 
ever followed, and notwithstanding that I have often 
attended on small-pox patients, and almost recklessly ex- 
posed myself to the contagion, yet no effect has ever been 
experienced, except that about the proper time for the 
disease to manifest itself after my first exposure to the 
small-pox contagion — which was about forty years after 
vaccination — I had the symptoms of the first stage of 
fever, which lasted about twelve hours, and then subsided 



VACCINE DISEASE. 201 

without the use of any means. This, I presume, was 
a slight varioloid fever, but there was not a sufficient 
amount of susceptibility to manufacture any eruption. I 
have seen many other cases of varioloid fever without 
eruption. For the last twenty years I have rarely passed 
a season without having small-pox patients, and have 
taken no care to avoid the contagion. My observation 
leads me to believe that if the system be once protected 
by vaccination, that it may be for all future time more im- 
plicitly relied on as an immunity from small-pox than hav- 
ing had the small-pox itself. I have seen within the last 
few years several cases of genuine small-pox — one of which 
was confluent — in persons who had had the disease before, 
and who carried the unmistakable marks of it upon their 
persons. This, I know, has been positively denied by 
eminent authors, but u seeing is believing," and I could 
produce a score of witnesses that in Edgefield, a few years 
since, there occurred several cases of small-pox in persons 
who had had that disease before. I now urge all persons 
to be vaccinated, although they may be pockmarked. 

It is a great misfortune that as yet no means has been 
discovered by which the vaccine virus can be kept for any 
considerable length of time in a condition to be relied on. 
I have tried all the methods which I have seen recom- 
mended, but uniformly failed to preserve it in an active 
condition for more than a few months. The best means I 
know of is to inclose 'a good firm scab in white wax, and 
keep it where it will not freeze or become over blood 
heat. In this way I have preserved it for several years 
in a condition that out of ten insertions one or two would 
take, and thus give me a start of active matter. A few 
years since the small-pox broke out where I was practic- 
ing, and no recent vaccine virus could be obtained. I took 
a scab which I knew to be three years old and made about 
thirty insertions, out of which -one proved effectual; from 
this, while in a fluid state, I vaccinated quite a number, 
not failing in a single instance. 



202 on fever: 

varicella, or chicken-pox. 

This is a contagious eruptive disease, which shows itself 
usually first upon the breast, shoulders, and back, whence 
it spreads to the scalp, face, and extremities. The face is 
less affected relatively than in small-pox. The pocks are 
sometimes numerous, though usually few, and almost always 
quite distinct. They first appear as small bright red spots, 
which quickly become vesicular, and sometimes they seem 
to break out in that form. The eruption is not unfrequently 
attended with itching or tingling, which causes the child to 
scratch and rub the vesicles, and thus to break them, when 
they often appear as small, formless red splotches. The 
unbroken vesicles are generally from the eighth to the sixth 
of an inch in diameter, occasionally somewhat larger, rounded 
at top, transparent, colorless, or* slightly yellow, and very 
delicate, so that they are easily ruptured. Sometimes they 
occur in successive crops for two or three days, and conse- 
quently appear in different stages of advancement. As 
they mature, they become a little yellowish, and somewhat 
opaque, so as, when at their height, on the fourth or fifth 
day, to have a pearly aspect. At this time they begin to 
shrink and dry ; and, on the sixth day, small brown crusts 
appear, which gradually harden, and fall off on the ninth or 
tenth day, leaving the surface slightly discolored, but not 
depressed. The last crop is sometimes a day or two later 
than the first in reaching maturity and separating. If much 
irritated, as by scratching or rubbing, the vesicles some- 
times become pustular, and then occasionally leaA^e pits. 
In certain rare cases of what seems to be varicella, umbili- 
cated vesicles appear mingled with the others, and some- 
times leave behind them small, round, deep pits. I have 
considered such cases as varicella, rather than varioloid, 
because no small-pox existed to which they could be traced. 
The conoidal and globular varieties of Bateman's synopsis 
are probably examples of varioloid. 

Cause. — The only known cause of chicken-pox is a pe- 
culiar contagion, unless we admit that it sometimes originates 
in an epidemic influence. The contagion is not powerful ; 



CHICKEN-POX, OR VARICELLA. 203 



and it is doubtful whether the disease can be communicated 
by inoculation. It is certain that repeated attempts to 
propagate it in this way have failed ; and the cases in which 
success is asserted to have been met with may very possibly 
have been varioloid disease, which has often been confounded 
with chicken-pox. One attack protects the system against 
a second. The disease sometimes occurs epidemically ; but 
whether independently of contagion is unknown. It is 
confined almost exclusively to children, though not entirely 
so. Cases have been observed in persons of middle age. 

"Varicella was for a long time confounded with variola ; 
but the distinction, when pointed out by Heberden and 
others, was generally recognized. Dr. John Thomson, of 
Edinburgh, revived the idea of their identity, considering 
them as different modifications of the same disease, and 
succeeded in creating doubts in many. But the following 
considerations are, I think, conclusive against that opinion. 
Chicken-pox often occurs in neighborhoods where there is 
no small-pox ; and epidemics of the former disease some- 
times occur without a case of the latter. It does not give 
rise to small-pox in the unprotected, but always to an affec- 
tion having the same symptoms as the original disease. It 
occurs with identical characters and with equal facility in 
the vaccinated and unvaccinated, in those who have had and 
those who have not had small-pox ; nor does it afford the 
least protection against small-pox or vaccination. The 
whole course of its symptoms is different from that of 
variola. The pock is essentially different from the vario- 
lous. It is a superficial vesicle, situated between the true 
skin and epidermis, without any pseudo-membranous pro- 
duct, and without any deep-seated disease of the corium. 

Diagnosis. — The only affection with which varicella can 
be confounded is varioloid, in some of its varieties. Indeed, 
I have occasionally met with cases, during the prevalence 
of small-pox, in relation to which it was impossible to 
decide, with certainty, whether they were variolous or 
varicellous. But generally, the distinction between modi- 
fied small-pox and chicken-pox is sufficiently obvious. In 
the former, the fever is more severe and longer continued. 



204 on fever: 

The eruption is muck later in assuming the vesicular cha- 
racter, is often umbilicated, and often more or less pustular. 
There is, moreover, a greater elevation and hardening of 
the surface in the pimple, and at the base of the vesicle, 
which is much firmer than that of varicella. 

Treatment. — The disease is never dangerous, and almost 
always so mild as to be quite insignificant. Its chief im- 
portance, in fact, consists in the possibility of occasionally 
confounding it with varioloid. Little treatment is required. 
In the severer forms of it, a dose of magnesia or a saline 
laxative, cooling drinks, and an antiphlogistic regimen may 
be prescribed ; and it is advisable, after the falling of the 
scabs, to immerse the child in a warm bath. So slight is 
the affection, that it is scarcely ever worth while to use any 
precautions against its propagation. 

SCARLATINA. 

Scarlet fever still continues to be the terror of households, 
and yearly furnishes its quota of bereaved parents. Some- 
times its ravages are fearful. Only last winter there lived 
in an adjoining county a gentleman and lady whose home 
was made glad by six lovely children ; but the destroyer 
came in the shape of scarlatina, and in less than ten days 
they were childless ! ! how desolate was that hearth ! 

This disease has been divided into three grades : Scarla- 
tina Simplex, Scarlatina Anginosa, and Scarlatina Maligna. 
And though these divisions are rather arbitrary — the differ- 
ent varieties often running into each other and blending in 
every possible manner — yet, as we often do meet with 
different cases of this disease presenting true types of each 
of the grades named, and as these cases must necessarily 
be treated differently, it is well to preserve these distinc- 
tions. 

Symptoms. — Scarlatina Simplex, or simple scarlet fever. 

In this form of the disease there is open reactionary 
fever, with an abundant scarlet eruption; skin hot, and 
pulse full, strong, and rapid. The skin seems to be the 
principal seat of the disease, the throat not much affected. 

The reverse of this is true of Scarlatina Anginosa : the 



SCARLATINA. 205 

throat here is the point of suffering, often swelling enor- 
mously, which, with a croupy exudation, which is frequently 
considerable, and exceedingly tenacious, often produces 
absolute suffocation. 

In this variety, the eruption is rather later in making its 
appearance, and is not so regularly diffused. Sometimes 
no eruption whatever takes place, though the disease might 
appear in the same family, a part of which had the eruption 
without the sore-throat. 

In Scarlatina Maligna, there is profound nervous pros- 
tration and great capillary torpor, shown by the purple 
hue of the surface. The fever is of a low type and very 
little eruption, and that coining and going as the capillary 
system varies in activity. 

The throat is but little swelled, but is often the seat of 
foul sloughing ulcers ; sometimes the little patient dies in 
the first stage, assuming many of the symptoms of col- 
lapse in Asiatic cholera. 

Treatment. — In simple scarlet fever, my treatment is 
exceedingly simple, and uniformly successful. 

In the forming stage, which usually lasts two days, this 
disease cannot be distinguished from the same stage of 
other fevers, and I treat it accordingly ; rubbing the spine 
with chloroform liniment, and giving the fever syrup in 
moderate doses, say a teaspoonful every two hours in a 
wine-glass of sweet milk. I expect by this treatment to 
allay the restlessness, and get up such a good state of 
capillary action, that should the disease threaten to assume 
the anginose or malignant form, it may be converted into 
the simple variety. It is the business of the nerves and 
capillaries to manufacture the eruption, and I presume if 
they are supported so as to perforin their office, the disease 
will always be open and simple. 

When the eruption makes its appearance, if it is very 
profuse, and the heat of the surface great, I have the sur- 
face sponged with tepid water and then greased : a piece of 
smoked bacon rind is thought to answer best for this greas- 
ing — perhaps on account of the empyreumatic oil which it 
has imbibed — but any mild oil will answer pretty well. 



206 on fever: 

If there is great thirst, I order small and frequently 
repeated doses of epsom salts, say what you can lift on the 
end of a teaspoon-handle, given in as much cold water as 
the child will drink at one time. If this should operate too 
freely upon the bowels, it must be discontinued, and two or 
three grains of Dover's powder given. The eruption will 
begin to fade in four or five days, and if there have been 
no complications, the child will speedily recover. 

In Scarlatina Anginosa, besides the treatment already 
given, prompt attention must be paid to the throat ; the 
inflammation must be assuaged, and the swelling of the 
glands reduced, or suffocation may take place very speedily. 
For the first, I use weak pepper tea, sweetened to the taste, 
(honey should be used if it can be obtained,) with the addi- 
tion of two grains of ipecac, to a pint of tea : recollect 
that the tea must be weak ; many are in the habit of giving 
it strong, but this has a tendency to produce dryness of the 
throat by checking secretion, whereas the weak tea merely 
excites sufficiently to promote secretion. I usually use the 
cold infusion, made by putting a few grains of cayenne or 
a pod of common red pepper in a glass of cold water, 
removing the pod whenever it has imparted a slight pun- 
gency to the Avater, putting it in another glass of water, 
to be ready for use by the time the first is used ; this drink 
will be taken kindly, and may be used freely. The throat 
should be enveloped with flannel, saturated with vinegar 
which has had as much common salt added to it as it will 
dissolve. This should be applied as hot as can well be 
borne, and often renewed; a dry cloth, well oiled or 
greased, should be applied over the wet one, to prevent 
cold from evaporation. A teaspoonful of the syrup should 
be given every two hours in sweet milk, or emulsion of 
slippery-elm or gum-arabic, to cover its acrimony. As soon 
as the inflammation is partly subdued, it is best to discon- 
tinue the wet cloth, and use some strong stimulating lini- 
ment. Either of the following which may be most con- 
veniently obtained will answer : Chloroform liniment ; vol. 
lin. ; aqua ammonia and spirits of turpentine, equal parts ; 
or strong vinegar and tincture of capsicum. The bowels 



SCARLATINA. 207 

should be kept open with small closes of epsom salts, but 
no active purgative should be given. Under the best man- 
agement, one or more of the glands often suppurate ; when 
this is found to be inevitable, it is best to hasten the pro- 
cess by applying a lye poultice. After the abscess is 
opened, a slippery-elm poultice is best ; this should always 
be covered with a greased cloth, to prevent its adhering. 

In Scarlatina Maligna, the general treatment must be 
somewhat varied, and local applications wholly different 
from those recommended for the last variety. Here we 
have to contend with deficiency of vital energy, and every 
thing that is done must have reference to the vital neces- 
sity that exists of arousing nervous energy and increasing 
capillary action. The fever syrup should be given in table- 
spoonful doses ; and if this should disagree with the 
stomach, carb. of ammonia must be substituted ; a good 
formula is, Emulsion of slippery-elm or of gum-arabic, six 
ounces ; carb. am., one drachm ; give a tablespoonful every 
hour until an effect is produced. As a gargle, use tine, 
capsicum, one ounce ; mucilage, half a pint, and if the 
patient swallow it, all the better ; or chloroform liniment 
may be substituted for the capsicum. The throat should 
be enveloped with flannel saturated with cold water — ice 
water is preferable. If no decided change take place for 
the better in a few hours, give the patient freely of brandy 
and water, and use the wet sheet. My habit is to give the 
brandy until some arterial excitement is gotten up, and 
then envelop the patient in a wet sheet, cover with one or 
two blankets, and apply hot bricks to the feet and about 
the extremities. As soon as reaction has fairly taken 
place, remove the sheet, and lay the patient between two 
dry blankets. Recollect we are striving after reaction, and 
do not want perspiration, and on this account the sheet 
should be removed as soon as it has accomplished this im- 
portant office. If the blankets become annoying, change 
them for sheets. It is very fashionable to cauterize the 
throat in malignant scarlet fever with nitrate of silver, but I 
never do it until after ulcers are formed ; it then proves very 
beneficial, by giving a more healthy character to the ulcers. 
14 * 



208 on fever: 

Now my experience is, that unless the case be. one of 
those terrible ones in which the system at once collapses 
under the power of the poison, a free use of the fever syrup in 
the early stage of this disease will convert a case that 
would have proved to be malignant, into the simple reac- 
tionary form. I have had no case of malignant scarlet 
fever for many years, in which I was early consulted, and 
I suppose I should have had many but for the treatment, 
as they have occurred yearly in this city and vicinity in 
the practice of others, some of which died in less than 
twelve hours. On the contrary, a plain case of simple 
scarlet fever may certainly be converted into the malig- 
nant form by improper treatment. A case in point occur- 
red in my own practice many years ago, which made an 
impression upon my mind never to be effaced, which, as it 
presents several points of interest, will here be given. 

The patient was my only child, a sprightly daughter of 
about six years. 

The undisputed doctrine then was to stimulate in the 
eruptive stage, in order to obtain a plentiful crop. She 
accordingly was covered up, and encouraged to drink freely 
of warm teas. Under this regimen there was soon rather 
a surplus crop of eruption, and the heat and restlessness 
were so great that I w r as forced to allay them by covering 
her lightly, and rubbing her all over with wheat flour. 
Having obtained a period of comparative quiet, and con- 
sidering the case doing very well, I withdrew my attention 
for about two hours. On again examining her, I found 
that a change had come over the case : her breathing was 
hurried and anxious, considerable stupor, the eruption 
rather purple ; and on looking into her mouth, a sight was 
presented calculated to shock parental sensibility to the 
utmost. The whole lining membrane of the mouth was of 
a mahogany color, deepening as it approached the fauces, 
where it had become entirely black, showing that decompo- 
sition had already commenced. For a moment I was past 
thinking ; but rallying, I began to cast about for some 
means which might give a chance. As I had never seen a 
parallel case recover, I had no satisfactory experience to 



SCARLATINA. 209 

fall back upon ; but the object to be effected was very evi- 
dent. — general reaction must be established, and the gan- 
grene arrested, or death must ensue in a few hours. After 
administering some unadulterated brandy, and perceiving 
that sensibility of the glottis and fauces was destroyed, I 
ventured to put a few drops of undiluted aqua ammonia on 
the back part of her tongue, which was swallowed with 
the ease of water ; I repeated it every few minutes, each 
time increasing the dose, until a full teaspoonful was swal- 
lowed at once — taking the precaution to give freely of cold 
water immediately preceding each dose, so as to prevent 
its irritating the stomach, at the same time that the full 
stimulating effect might be received by the dying tissues. 
In half an hour I perceived a salutary change : general 
arterial action was improved, capillary action better, mani- 
fested by a more florid color of the eruption ; and, on 
examining her mouth and throat, I discovered that the 
mahogany color had faded considerably, so as to show a 
well-defined outline to the area of the mortification. I now 
discontinued the ammonia, and substituted strong pepper tea; 
this was discontinued in an hour or two, as the returned 
sensibility of the mouth and tongue caused its pungenc}^ to 
annoy her, and also because reaction was now quite satis- 
factory. A drink of the juice of green sage, diluted with 
water and sweetened with honey, was now given. 

On the next day I had the satisfaction to see the black- 
ened covering of the fauces cast off, exposing a very 
healthy but very irritable mucous membrane. Recovery 
was now rapid and without accident. 

The points of interest in this case are : first, that it cer- 
tainly was Scarlatina Simplex at the beginning, but was con- 
verted into Scarlatina Maligna by improper stimulation, 
producing excessive eruption, and this causing so much 
nervous excitement as to produce nervous and capillary 
prostration. Second, that by powerful stimulation the 
malignant form was made to yield to the original type, it 
terminating in the ordinary happy manner of Scarlatina 
Simplex. The third is, that it affords encouragement to 
persevere under difficulties, and not give up a case because 



210 ON FEVER : 

heretofore we have been unsuccessful. The fourth is, that 
it illustrates the fact that desperate conditions often war- 
rant the use of what, under ordinary circumstances, would 
be desperate remedies. At present I would not in a like 
case depend so exclusively upon ammonia, and should not 
then, but for the fact that there was nothing else suitable 
at hand. I had often used the oil of sassafras alone, and 
in combination with ammonia, for arresting external gan- 
grene, but there was then none in reach. At present I 
would rely upon the chloroform liniment. I will take the 
present occasion, as perhaps as suitable as any other that 
will occur, for saying something more upon the danger of 
excessive external stimulation producing fatal prostration. 
We meet with examples of it in all the eruptive diseases ; 
from excessive blistering of young children; from extensive 
though very slight burns ; and among the children of the 
poor or careless inhabitants of our hot and well-supplied 
mosquito city, I have frequently been called to visit babes 
who had been suffered to lie naked in order to keep cool, 
who presented very alarming symptoms of prostration of 
vital energy, and after careful examination and inquiry I 
could find no sufficient cause, except in the fact that the 
surface was densely covered with mosquito bites. An 
anodyne internally, with a little brandy as a soothing wash 
for the surface, have always proved sufficient to relieve 
such cases. In order to impress this subject upon the mind 
of my readers, I will give a short history of a fatal case 
that I witnessed some years ago. 

A gentleman, a mile or two from the village in which I 
then lived, called on me one evening, saying that there was 
a case at his house that he did not understand, and came to 
state it, that I might decide whether any thing was wrong. 
He informed that on the previous day a little negro girl 
had her calico slip to take fire ; but as he was near at hand, 
he succeeded in tearing it off before she was seriously 
burned ; that after the first half hour she ceased to make 
any complaint of the burn, but, what was singular, had 
gone to sleep and could not be aroused. I told him that 
his negro would certainly die, which surprised him exceed- 



SCARLATINA. 211 

ingly ; lie insisted, however, that I should see her, and I 
did so. 

I found that the burning garment had slightly scorched 
the whole surface, but only in a few small places sufficiently 
to excite vesication; her pulse was scarcely perceptible, 
and the whole surface cool; respiration very slow and 
languid ; coma complete. I made some vigorous efforts to 
stimulate, but to no purpose — the system would not respond, 
and in two hours she died. Some persons may imagine 
that my teaching and practice upon the subject of stimu- 
lating in the eruptive stage of scarlet fever are contradictory 
— that I prescribe the fever syrup, which is a powerful 
stimulant. But I would have such to understand that the 
comp. syr. of val. is not a general stimulant, especially not 
an arterial stimulant. Its effects are to quiet the nervous 
system and excite the capillaries, thereby preventing that 
kind of morbid excitement which produces excessive erup- 
tion. It is true I have said that it is the business of the 
nerves and capillaries to manufacture the eruption; but if 
they are preserved in sound condition, they will do this as 
it should be done, neither half doing nor overdoing their 
task, and it is the natural effect of this medicine to preserve 
or put them in proper working order. The operation of the 
fever syrup in high febrile and inflammatory diseases is 
graphically and truthfully set forth in a communication from 
a very intelligent correspondent. After stating its beneficial 
effects in the treatment of a number of active inflammatory 
diseases, he states : 

" The only inflammation in which your fever syrup is 
contra-indicated is gastritis ; here it acts as a direct irritant ; 
but by the time it reaches the bowels, it is so modified as 
not to act injuriously; on the contrary, I have derived great 
advantage from it in chronic dysentery and inflammation of 
the bowels ; and when it reaches the capillaries, it there 
sets every thing right again ; the pain, irritation, and heat 
subsile, the engorgement disappears, and all move on natu- 
rally and pleasantly again." 

Now, if it would act as above in active inflammation, is it 



212 ON FEVER : 

probable that it would increase febrile excitement? The 
very opposite is its legitimate effect. 

Seqikela of Scarlatina. — The diseases which sometimes 
follow scarlet fever are often more formidable than the 
disease itself, especially as they are most apt to follow the 
mildest cases. 

This has been supposed to be owing to the poison not 
having been properly eliminated from the system, which I 
think is a rather groundless conjecture. A much more 
plausible reason is this : the disturbance in a very mild case 
is not sufficient to produce reaction sufficient to restore 
activity to the capillaries ; and though capillary debility 
seems to be slight, yet it remains, and as the patient is not 
sick enough to be kept in-doors, some exposure renders the 
capillary debility more intense, and it runs into active 
inflammation, or the debility becomes profound, and pro- 
duces such a state of relaxation as will admit the watery 
part of the blood to exude into the cellular structure, or 
upon the serous surfaces, causing general or partial dropsy. 
With this view of the subject, the means of relief naturally 
suggest themselves. Give the fever syrup freely in water- 
melon seed tea, and promote the secretion of the bowels 
and kidneys with salts and cream of tartar. Under this 
treatment the dropsy will speedily disappear. 

D. C. A. Moses, M.D., Eldridge, Ala., writes : 

" You say nothing in your work of using your fever 
syrup in dropsy. Now, if you never have used it in such 
cases, give it a trial — it will not disappoint you. The cases 
that I have used it in are such as are recognized by the 
profession generally as incurable, cases of long standing in 
the old and feeble, and which depend upon general atony 
of the whole system." 

The dropsy following scarlatina, we have seen, depends 
essentially upon debility ; therefore the above is in point. 

As to the inflammations, glandular swellings, etc., which 
sometimes follow scarlatina, if they be treated on the general 
principles laid down in this work, or according to enlightened 
common sense, there will be but little difficulty in managing 
them ; though patience may become a virtue before a com- 



RUBEOLA MEASLES. 213 

plete cure is obtained. After the prominent disease has 
been pretty well managed, chalybeates are often of great 
service. 

The treatment in scarlet fever by Wood, Watson, and 
other standard authors, is substantially the same, and is as 
follows : 

In the simple variety, very little treatment is thought 
necessary ; keeping within doors, simple diet, and opening 
the bowels by cooling laxatives, being sufficient. 

In the anginose variety, emetics, calomel, saline purga- 
tives, sponging the surface with cold water when hot, 
bleeding if the inflammatory action runs high, (cupping or 
leeching is preferred,) cooling drinks, etc.; and if the 
energies of the system seem to fail, stimulants, as wine, 
brandy, quinine, camphor, carb. ammonia, etc., are to be 
resorted to. 

If the throat is much swelled, leeching, poultices contain- 
ing pepper, turpentine, etc., are directed ; also gargles of 
pepper tea, or astringents, such as alum, sul. zinc, etc. 

In the malignant variety, known as putrid sore-throat, 
stimulants, tonics, and opiates are relied on. I have 
nothing to offer against the above treatment, but I have 
shown you " a more excellent way." 

RUBEOLA MEASLES. 

Much that has been said under the head of scarlatina is 
equally applicable to measles, and need not be repeated. 
Its diagnostic symptoms are cough, suffusion of the eyes, 
irritation of the mucous membrane of the nose, fauces, and 
air-passages, causing sneezing, running at the nose, cough, 
etc. These are attended with more decided symptoms of 
fever than ordinarily accompany common catarrh; but 
nothing positive can be known until the eruption appears, 
which will be about the fourth day of the fever. 

The eruption appears in form of small red points, mostly 
grouped into circles or semicircles, of about a line in diame- 
ter; these gradually coalesce, forming strawberry-colored 
blotches, slightly elevated above the surrounding surface ; 
they mostly appear first on the face, extending to the breast, 



214 on fever: 

arms, body, and lower extremities, in order; they also 
invade the mouth, fauces, and, at times, the whole respira- 
tory tubes. The blotches are usually entirely distinct, 
having more or less surface between them of a natural color, 
but sometimes they become confluent on the face, breast, 
and upper part of the arms. After the eruption fully 
appears, it relieves, in a great measure, the sickness, which 
at first is very annoying, but does not give much relief to 
the pulmonary disturbance, and the fever has no tendency 
now to abate, as in small-pox. In five or six days, both 
the fever and eruption begin to decline ; the tongue, which 
had been intensely red, begins to assume a more natural 
appearance, the appetite returns, and the surface casts off 
its epithelium in the form of scales. 

Diarrhoea is a frequent attendant on this disease, and, if 
not very severe, proves salutary. 

Treatment. — In most cases of measles, very little should 
be done ; bland drinks, un stimulating teas, such as balm, 
wild sage, etc., with two or three teaspoonfuls of the fever 
syrup in the course of the day, are all that is required. 
Nothing should be given to "strike out the measles;" no 
efforts will succeed until the proper time arrives, and then 
you cannot keep them back if you try. But injudicious 
efforts to bring out the eruption, often do much harm, by 
increasing the crop to a dangerous extent. • 

If the fever be very high, and there be great heat of the 
surface, tepid sponging may be resorted to, and two or three 
grains of ipecac, added to a glass of cold water or mild tea, 
and the patient directed to take a swallow at short intervals. 
If the patient, on the contrary, is rather cool and restless, 
a few pretty full doses of the fever syrup, with a few grains 
of Dover's powder, will bring them to the right point. 
After the eruption is out, unless there are complications, I 
do nothing except to give the fever syrup in small doses ; 
the best manner of exhibition is to add a teaspoonful to a 
glass of cold water, and allow them to drink that quantity 
every two or three hours. The syrup undoubtedly mode- 
rates the fever, and prevents all accidents from damp or 
cold, which are so often met with, and which are often 



RUBEOLA MEASLES. 215 

serious ; given in the above form, it enables the patient to 
drink a sufficient amount of water to supply the wants of 
the system without offence to the stomach, or injury any 
way. If the cough is very troublesome, and pulmonary 
distress considerable, add two grains of ipecac, and five of 
Dover's powder to a glass of mucilage, and give a table- 
spoonful every half hour. 

Occasionally the brain becomes deeply involved in this 
disease, and requires very prompt attention. In slight 
cases, a cold wet cloth to the forehead will be sufficient ; 
but I had a case, a few years since, which required the 
whole head to be enveloped with pounded ice, which had 
to be continually applied for nearly forty-eight hours ; the 
disease then yielded, leaving no unpleasant results. 

To allay excessive itching and burning of the surface, 
wash and grease as directed for scarlatina. Great care 
should be taken, during convalescence, to avoid cold and 
exposure. If any unpleasant sequoela follow, they must be 
treated upon general principles. 

Recapitulation : — Time after the contagion is received 
until, the disease begins to manifest itself, about fourteen 
days ; forming stage, four days ; eruptive stage, ordinarily, 
seven days ; under the use of the fever syrup, from three 
to four days. 

Can the contagion be prevented from taking effect? I 
think it can. 

For nearly thirty years I have been in the habit of using 
a means for this purpose which, so far as ever came to my 
knowledge, has never failed ; this is the odor of turpentine. 
The manner in which I use it is to saturate a woollen cord, 
or, what is better, a slip of buckskin, and apply it around 
the neck, so as to fall pretty low down, resting upon the 
under garment and being hidden by the outer ; it must not 
touch the skin, or it will irritate the sensitive surface of a 
child excessively. 

The first time I saw this remedy tried was on a crowded 
steamboat on the Ohio river. A case of measles occurred, 
and there were many unprotected persons aboard. I re- 
mained with the most of these long enough to know that 



216 on fever: 

the disease was not contracted. Since then I have always 
recommended mothers to use this precaution when taking 
their children to camp-meetings and other public assem- 
blages, when the disease was known to be in the vicinity ; 
and, so far as negative evidence can prove any thing, trials 
enough have been made to settle the question as to its 
power. 

ERYSIPELATOUS FEVER ERYSIPELAS. 

Erysipelas is often a local disease, arising from local 
causes, as wounds, etc. ; but, as it also not unfrequently 
appears as a distinct idiopathic fever, and is sometimes even 
epidemic, it may properly be classed with particular fevers 
of the eruptive kind. This disease is usually ushered in 
with the common symptoms of the first stage of fever, viz. : 
languor, general uneasiness, aching or soreness in the limbs 
and joints, chilliness, or rigors, alternating with flushes of 
heat, succeeded by a frequent pulse, hot skin, a furred 
tongue, anorexia, thirst, sometimes nausea and vomiting, 
headache, restlessness, muscular weakness, and not unfre- 
quently soreness of throat, or swelling of the lymphatic 
glands in the vicinity of the part which is to be the seat of 
the cutaneous inflammation, as of the neck in erysipelas of 
the face, and of the axilla or groin in that of the extremi- 
ties. 

On the second or third day of the fever, though some- 
times earlier and sometimes later, and occasionally as the 
first observable phenomenon, there may be seen, upon some 
part of the surface, a small reddish spot, usually somewhat 
elevated, painful, and tender to the touch. This may occur 
upon any portion of the body, but is much more frequent 
upon the face than elsewhere, especially upon the side of 
the nose, the cheek, or the rim of the ear. The inflamed 
spot gradually spreads, usually in all directions, though often 
more rapidly in one than in another, exhibiting almost 
always as it advances an irregular, abrupt, and somewhat 
elevated margin, which forms a striking boundary between 
the sound and the diseased skin. In some instances the 
border is less definite, though scarcely ever gradually shaded 



ERYSIPELATOUS FEVER ERYSIPELAS. 217 

off like ordinary inflammation, so that it cannot be traced. 
The diseased surface is red, often shining, hot to the hand, 
and generally harder than the sound skin. The redness 
disappears under the pressure of the ringer, but quickly re- 
turns when the pressure is removed. The distance to which 
the inflammation extends differs greatly. In some instances 
it advances slowly, and is confined within narrow limits ; in 
others it spreads quickly over large portions of the surface, 
and, in certain comparatively rare cases, does not cease to 
make progress until it has invaded successively every part 
of the skin. Almost always its progress is continuous ; but 
now and then instances occur in which it attacks in succes- 
sion separate and even distant parts of the body. 

In the face, it sometimes confines itself within the limits 
of the features, but generally has a tendency to spread up- 
ward to the scalp, and not unfrequently extends over the 
whole head, and even downward to the neck, though rarely 
so far as the chest. 

There is usually considerable swelling, the skin being 
thickened and hardened, and the subcutaneous cellular tissue 
in general more or less distended, especially in parts of loose 
texture, as in the eyelids and about the eyes, in the scrotum 
and prepuce, and in the vulva, which parts are apt to become 
strikingly edematous. 

The face is often so much swollen that every character- 
istic feature is obliterated. The eyes are closed, the lips, 
nose, cheeks, and ears greatly enlarged, the nostrils so much 
obstructed that the patient cannot breathe through them, 
the mouth so stiff that he speaks with difficulty, and the 
external orifice of the ear sometimes so much narrowed as 
to interfere with hearing. When the disease extends over 
the scalp, this is usually much swollen and puffy, and the 
whole head sometimes enormously enlarged. 

A burning, tensive, pricking, and smarting pain is usually 
experienced, and the parts are so tender that pressure pro- 
duces much uneasiness. When the whole scalp is affected, 
it is difficult for the patient to find a comfortable position 
for the head. The pain, however, often remits. 

Sometimes the inflammation gradually rises for three or 



218 ON FEVER : 

four days, then gradually subsides, without apparent effu- 
sion of any kind, and terminates in desquamation ; [scaling 
off.] But more frequently, about the third or fourth day, 
the cuticle is elevated by a serous liquid, which sometimes 
appears in the form of minute vesicles, sometimes blisters 
or blebs, like the bullse of pemphigus, from a quarter of an 
inch to an inch or more in diameter, which occasionally run 
together, so as to produce an extensive blistered surface. 
The surface is often moistened by exudation from these 
vesicles, or their rupture. On the fifth or sixth day they 
begin to dry, and on the seventh or eighth form small crusts 
or scales, which usually separate by the tenth, leaving the 
skin covered with a new cuticle. When the hands or feet 
have been affected, the cuticle sometimes separates entire, 
so as to form a mould of these parts. The redness and 
swelling subside at the same time, and are nearly or quite 
gone when the crusts are fully formed. The whole duration 
of the inflammation is thus, in favorable cases, about a week, 
though sometimes shorter, especially in the young and 
healthy, and sometimes, from various causes, considerably 
protracted. Even after desquamation, it is sometimes 
long before the skin acquires its natural appearance and 
flexibility. 

The course of the disease often varies more or less from 
that above described. Thus, while the part first affected is 
going through the regular changes, the inflammation may 
have advanced to another part, which goes through its own 
periods of advance and decline ; and so on with different 
parts successively, so that the disease may be prolonged for 
a month or more. 

After the removal of the cuticle from the vesicated parts, 
the surface sometimes continues to exude an acrid lymph for 
several days, and may even pass into a state of suppuration 
or ulceration, which greatly retards the cure. 

In some cases the inflammation in the subcutaneous tissue 
ends in suppuration, and even in gangrene of the cellular 
tissue. In the former case, pus of a healthy appearance 
escapes through ulcerated openings in the skin ; in the latter, 
grayish strings of the dead membrane, like wet tow, come 



EEYSIPELATOUS FEVER ERYSIPELAS. 219 

away, along with a thin, ichorous, and fetid purulent dis- 
charge. The face sometimes presents the disease at once 
in its different forms : portions undergoing resolution with- 
out vesication, others exhibiting vesicles on the surface, and 
others, as the parts about the eye, discharging pus and dis- 
organized cellular tissue. The tissue beneath the scalp not 
unfrequently, in bad cases, passes into this gangrenous state, 
though the skin itself generally remains sound, except when 
ulcerated to permit the escape of the dead matter. But 
this condition of the disease is still more frequent upon the 
limbs and trunk. In these parts, the pus not being duly 
confined, as in phlegmonous inflammation, by the exudation 
of coagulable lymph, often travels great distances, destroy- 
ing the subcutaneous cellular and adipose tissue, dissecting 
the muscles, and involving life in great danger. Even 
where recovery takes place in such cases, deformity may 
ensue from the resulting contraction, and difficulty of move- 
ment from the adhesions which may form among the muscles, 
or between them and the skin. Sometimes gangrene of the 
skin itself is added to the various mischief. This happens 
more especially in the extremities. It is obvious that in all 
these cases, when not fatal, recovery must be considerably 
postponed. 

During the continuance of the cutaneous inflammation, 
the fever also continues, and sometimes in a greatly aggra- 
vated form. In vigorous constitutions, with no asthenic 
tendency in the disease, the pulse remains full and tens-e, 
without -being very frequent ; and, unless the inflammation 
invades the scalp, though there may be a little occasional 
delirium, the fever has generally an open inflammatory 
character, and offers little to cause alarm. But when the 
scalp is involved, symptoms of cerebral disorder are very 
often evinced, such as headache, tinnitus aurium, restless- 
ness, and decided delirium, or, what is perhaps more fre- 
quent, and constitutes one of the most striking features of 
these cases, a tendency to drowsiness, stupor, and even 
coma. 



220 on fever: 

The most alarming form in which erysipelas has ever 
appeared is that known as black tongue. Some years since 
it prevailed in many parts of our country with great fatal- 
ity, and we still occasionally hear of its existence, but 
not in a form to produce such consternation as it did 
in the years of 1842 and 1843. In 1845 it prevailed 
pretty extensively within the bounds of my practice. 
My cases all recovered under apparently very simple 
treatment. I had the mouth and throat frequently 
washed with the following mixture: Decoction of oak 
bark, one pint; apple vinegar, one gill; carbonate of am- 
monia, one drachm (about a teaspoonful;) oil of " sassafras, 
thirty or forty drops. A tablespoonful of the above mix- 
ture was also given internally every two or three hours. 
I also gave two or three grains of sul. quinine every two 
or three hours, and had their bowels moved every day by 
castor oil. 

Erysipelas occurs at all seasons, but most frequently, as 
is asserted, in the spring and autumn. All ages are liable 
to it. Women are said to be more frequently affected than 
men. One attack offers no security against a second. 

The inflammation in erysipelas is of a peculiar nature, 
and derives that peculiarity from some not understood state 
of system, or from some equally unknown peculiarity of 
the cause. That it differs from ordinary inflammation is 
proved by its disposition to spread, the distinct boundary it 
preserves in spreading, the severe burning which attends it, 
its tendency to gangrene, and the indisposition it evinces 
to the secretion of coagulable lymph, which is so character- 
istic a product of phlegmonous inflammation. In the disease 
now under consideration, it is obvious that the fever, though 
it may be aggravated by the local affection, is wholly inde- 
pendent of it in its origin ; for it often precedes the inflam- 
mation by one, two, or three days. It is highly probable 
that, in cases of traumatic erysipelas — that arising from 
local causes — there may be the same constitutional state, but 
in a degree insufficient to excite fever without the aid of 
the local disease. 

It may be difficult or impossible to distinguish the initial 



ERYSIPELATOUS FEVER ERYSIPELAS. 221 

fever of erysipelas, before the appearance of the cutaneous 
affection, from many other febrile diseases ; but Frank has 
pointed out a symptom which he considers diagnostic ; and 
Chomel and Blache in relation to it make the following 
observation : " Whenever a patient has exhibited, for 
twenty-four or forty-eight hours, an intense febrile move- 
ment, attended with pain, swelling, and tenderness of the 
lymphatic glands of the neck, we have not hesitated to 
announce the approaching development of erysipelas, and in 
no case has the diagnosis been invalidated by the result." 

As the disease commonly appears in good constitutions, 
it very generally ends favorably. In erysipelas of the face, 
the chief danger arises from the brain becoming involved, 
and this is most likely to happen when the inflammation 
invades the scalp, though this last event often occurs with- 
out serious consequences. A sudden disappearance of the 
external disease, with the occurrence of symptoms indi- 
cating internal irritation or inflammation, is unfavorable. 
Such a metastasis is most likely to happen in the wandering 
variety. The phlegmonous form is, in other respects, more 
dangerous than the superficial. The gangrenous variety is 
very dangerous. The very old, the intemperate, and those 
already nearly worn out by previous disease, are apt to die. 
This is peculiarly the case in dropsy, in which a fatal 
erysipelas often attacks the swollen limbs, especially after 
punctures ; but death, in these instances, is only a little 
hastened. The disease is often fatal when it occurs near 
the close of febrile diseases ; though recoveries also, under 
such circumstances, often take place. The prognosis is 
always more unfavorable in hospital than in private prac- 
tice. In new-born children the disease is exceedingly fatal; 
as it also often is when it occurs epidemically, and whenever 
it puts on a malignant form. Coma and continued delirium 
are always unfavorable symptoms. 

I hope the reader will pardon me for being rather tedious 
in the description of erysipelas ; it is very important that 
he should be able to recognize the disease in its various 
forms, as the earlier the proper means are used for its sup- 
pression, the easier it is managed, and the less suffering will 



222 on fever: 

have to be endured. I have known several instances in 
which this disease started from an old sore, or a recent 
slight injury, in which one night's delay came near costing 
the patient's life, it having been mistaken for common 
inflammation. I will now give the treatment, and will be 
as short as possible, so as to give full, plain directions for 
managing the disease in all its varieties. 

As far as the fever is concerned, that must be treated 
upon general principles. The plan laid down, and so fully 
dwelt upon in the preceding pages, is applicable to all fevers 
— it strikes at once at the root of the matter;- for by 
removing the condition in which fever consists, the febrile 
movement will at once be arrested, and all the phenomena, 
or symptoms arising from it, will gradually subside. Now 
I have said, and I think clearly proven, that fever essen- 
tially consists in nervous disturbance and capillary inaction; 
and that when these are present there is fever, and when 
either of them is absent there is, and can be, no fever; and 
when it is recollected that the febrile movement is substan- 
tially the same, let the cause be what it may, it is not 
surprising that the same means are equally applicable to all 
its varieties and grades, and only require the doses to be 
varied so as to produce the desired effect, and such other 
means used as will aid the principal remedies and meet 
occasional complications, and remove local irritations which 
may tend to keep up or feed the fever. All this has been 
very plainly dwelt on, and I think fully explained, in the 
first part of this work; and I refer to the subject now as 
an apology for again bringing forward the same means 
which have so often been recommended in other varieties 
of fever. A general complaint urged against family medical 
works has been, that they recommend such a variety of 
medicines, many of which are so difficult to obtain, that it 
becomes impossible to pursue the directions — in fact, it is less 
trouble and less expense to employ a physician, than to 
procure, and keep on hand, the necessary means to follow 
out the author's directions. The complaint, I fear, will be 
of an opposite kind with regard to this work ; for as I 
believe that the principles or laws which govern diseased 



ERYSIPELATOUS FEVER ERYSIPELAS. 223 

action are few, however various and complicated the symp- 
toms may be, I also believe that a few remedies, properly 
chosen and properly administered, and at the right time, 
are capable of controlling diseased action in all its forms ; 
and thus the practice of medicine is very much simplified 
and made plain ; so that any person of good common sense 
can very successfully contend with disease in its various 
manifestations, or even prescribe with judgment and good 
effect in cases which had never been seen before. I have 
never used many remedies in my own practice, and I will 
not, in order to appear learned, burden my readers with 
more than I would use myself. 

While attending in epidemic dysentery some years ago, 
I frequently had half a dozen patients in the same house ; 
on one occasion the nurse observed that it was no trouble 
to follow my directions — that my remedies were so few and 
so easily given, that she had no difficulty in attending to 
all the cases ; whereas, the physicians who had preceded 
me, ordered so many things for each patient, and each 
differing from the others, that she became bewildered and 
could not carry out the directions; and, consequently, was 
blamed for the want of success which followed. It is true, 
there should, besides the means most relied on, be. other 
means suggested that may be resorted to, should the best 
not be at hand ; or any peculiarity in the case, or suscepti- 
bility of the patient, render the use of the others improper. 
This I have attended to ; always selecting such as will be 
most likely to be at hand, or easily obtained. Another 
advantage that arises from prescribing the same remedy in 
preference to a new one, whenever it will answer as well, is, 
that we become more thoroughly familiar with its mode of 
action, and the effects it should produce ; so that we are 
prepared at once, should a change come over the case, to 
decide whether it is the effect of the medicine or of some 
other cause. But lest I weary the reader, I will proceed 
to give the treatment of erysipelas. The fever, as before 
remarked, should be treated like any other fever of the 
same grade and in the same stage ; in fact, until the erup- 
tion appears, no one can say whether the fever is erysipe- 
15 



224 on fever: 

latous or not, it being attended with the very same symp- 
toms which precede small-pox, scarlet fever, measles, or 
ordinary bilious or typhoid fever ; so that if we had to wait 
until we were certain what the proper name of the fever 
should be, we would always lose much valuable time, and 
often the only time in which the disease can be so managed 
as to abort or break it up at once, and prevent much suffering 
and risk of life. If, therefore, you have a case of sickness 
presenting the common symptoms of the first stage of fever, 
do not wait to name it, but proceed at once to treat it. 
Rub the spine with the chloroform liniment to ease the 
pains or aches, or other distress which the patient may be 
suffering; for even should there be no uneasiness of the 
back, yet we know that the nerves originate there, which 
are distributed over the body, and which are complaining 
at the place where they terminate ; and that if they are 
quieted at their origin, they will also become quiet, and 
cease to complain, at their termination. But if you have no 
chloroform liniment at hand, use the next best remedy 
which you do have, viz., camphor and laudanum, or cam- 
phor alone ; or apply a flannel, wrung out of hot mustard 
water, all along the back-bone, or rub the back with vinegar 
or spirits of turpentine, and then apply the flannel wrung 
out of simple hot water. At the same time, let the feet be 
bathed in very warm water, as warm as can be borne, with 
mustard, or salt, or ashes in it. 

These means will give present relief from suffering, and 
prepare the system to be more easily brought under the 
influence of internal remedies. At the same time that you 
are doing these things, you should give the fever st/rup in 
such doses as will agree with the patient's age, or suscepti- 
bility ; children, and delicate nervous females, will require 
less than others, unless the disease has rendered the sys- 
tem partly insensible to impressions ; in such cases they 
will require as much as a strong man. A child six months 
old will bear a teaspoonful very well, provided it is given 
in one or two tablespoonfuls of ' sweet milk; it should 
always be given in milk to children, and to older persons 
too, unless the milk is repulsive ; then it should be given in 



ERYSIPELATOUS FEVER ERYSIPELAS. 225 

slippery-elm water, or it may be taken in plain water, but 
it will then be more pungent; but to some persons this 
pungency is rather agreeable. The ordinary dose for a 
grown person is from a half to a full tablespoonful, and 
should be repeated every two or three hours. There is no 
danger in an overdose of this medicine; the only disad- 
vantage will be a little too much temporary excitement 
and a waste of medicine. But if the syrup is given with- 
out being diluted with something to lessen its pungency, it 
sometimes impresses the nerves of the stomach so power- 
fully as to cause very unpleasant symptoms in nervous or 
excitable persons, and though no bad effects will follow, 
yet the patient will afterwards dread to take the medicine ; 
so that I would impress it upon my readers to always give 
it in milk, or some vehicle that will lessen its pungency. 
If you have not got the syrup, give a third of a teacupful 
of boneset or vervine tea, with a teaspoonful of Bateman's 
drops or paregoric to each dose, and repeat it every two 
hours, until there is a pleasant excitement on the surface, 
and the patient feels relieved ; then give a tablespoonful of 
castor oil or epsom salts, and let the patient have as much 
mild tea, such as wild sage, balm, or queen of the meadow, 
as may be desired. If these teas should not satisfy the 
thirst, cold water, or a weak leverage^ made by adding a little 
vinegar to the water and sweetening, if desired ; or lemon- 
ade, or cream of tartar, may be allowed as freely as the 
patient desires. 

I have now run over my general plan of treating the 
first stage of fever, though it had been given before, so as 
to save the reader the trouble of hunting it up, and also to 
impress the subject upon his mind, should he even have 
recently read what I ■ have before said. Now the only 
difference that need be made in treating; the mildest and the 
gravest cases of fever is, that the latter will require larger 
doses of the syrup, or other medicines given in its stead ; 
and that the external means recommended should be more 
fully carried out than would be absolutely necessary in 
milder attacks. Even the most congestive form in which 
I have ever seen this fever appear, has yielded to this 



226 ON FEVER: 

treatment ; and I should expect to see it succeed, should I 
meet with a case of that form known as black tongue ; for, 
as has already been shown from the symptoms of this 
variety, it consists essentially in the same general train of 
morbid action that characterizes other forms of the disease, 
and will of course be amenable to the influence of the same 
curative means which control them, only requiring that the 
remedies be given in doses proportionate to the virulence 
of the disease. Much may be accomplished by external 
remedies in the management of erysipelas ; in fact, when 
the disease has a local origin, and before the constitution 
has become so influenced as to produce fever, it may often 
be successfully controlled by external means alone. 

The oil of sassafras seems to exert some peculiar power 
over this form of inflammation, often arresting its progress 
at once ; but I seldom use it alone, as it sometimes fails, or 
is slow in its action. The chloroform liniment I think may. 
be considered a specific for this disease, having never failed 
in my hands, or in the hands of others, so far as I have 
been informed, in putting an immediate stop to the exten- 
sion of the inflammation, or of giving prompt relief to the 
burning torment arising from the part already affected. 
But its application is attended with momentary acute suffer- 
ing, and therefore must be applied to a small part at a 
time ; its application to a large surface might cause too 
much nervous disturbance. 

A few years ago I had a severe case of erysipelas of the 
face under treatment. The patient was a lady of excitable 
temperament, and the burning effect of the liniment, even 
to a small surface, she thought too much to endure, and 
refused to submit to a further application. Other means 
were tried ; the surface was cauterized with nitrate of 
silver, (a popular remedy,) but the disease quickly leaped 
over the black line which it made, nor did it materially 
abate the burning in the surface to which it was applied ; 
cooling applications were resorted to, but only gave tempo- 
rary and partial relief; finally, the disease extended to the 
ears, and the burning in the rims and pendent parts was so 
intense as to cause her to tremble as from a fit of ague, and 



ERYSIPELATOUS FEVER ERYSIPELAS. 227 

weep like an infant. I now persuaded her to apply the 
liniment herself to a very small part that was burning the 
fiercest, and note the effect. She accordingly, with a 
camel's hair pencil, touched the tip of one of her ears, and 
found that, after smarting only for a moment, it left the 
part perfectly clear of suffering. This encouraged her to 
extend its application, so that in the course of a few hours 
she had gone over the whole inflamed surface, which 
involved the whole face and part of the head and neck, 
putting her at entire ease so far as the external disease was 
concerned. The fever syrup was given regularly ; and as 
there were strong symptoms of chill in the forenoon, with 
high fever in the afternoon, ten grains of quinine, and five 
of Dover powder, made into four pills, and one given every 
four hours, beginning as soon as the fever abated a little, 
broke up this periodicity in the disease, and materially 
assisted the syrup in breaking up the febrile movement : 
she was quite clear of disease on the fourth day after the 
first accession of the fever. 

But suppose that the liniment is not at hand, or will not 
be submitted to : a pretty good substitute may be found in 
the application of common good whiskey; for, however 
much this may aggravate an inflammation taken internally, 
it is certainly one of the most cooling and soothing external 
remedies we possess. The best mode of applying the 
whiskey is to saturate a soft cloth and cover the inflamed 
surface with it ; this cloth should be suffered to remain, and 
kept wet by pouring the spirits on it, or, what is a better 
way, by often applying another cloth over it which has 
been saturated with the whiskey. But whatever local 
remedy is used, nothing more can be expected from it 
than a relief of the surface already affected, for the disease, 
though beginning at a point on the surface, has done so 
because the system was in a certain condition which pre- 
pared this local part to take on this form of morbid action, 
and as long as this condition of the system continues, new 
points of attack will probably be made ; and it is only by 
removing this condition and the erysipelatous fever, which 
is its result, that the disease can be effectually arrested ; 



22,8 on fever: 

and the fever syrup, and other means already prescribed, 
will very shortly do this if persevered in for a few days. 
But it is very difficult to persuade people, and some doctors, 
that a fever can be broken up without some evacuations ; 
they have been in the habit of seeing fevers attacked with 
vomits, and purges, and sweats, and bleedings, etc., and 
the idea sticks fast that there must be something in the 
system that has to be brought out by some or all of these 
means before a fever can be made to give way. But if 
fever is a mere condition of the system, when we change 
that condition, of course the fever will also disappear ; and 
that it is so has been already sufficiently proved, and made 
doubly certain by the almost uniform success which has 
followed the treatment which has been suggested by this 
view of its nature. When erysipelas is deep-seated, the 
liniment will not subdue it as promptly as when on the 
surface, but still it is the best application I know of; and 
where the disease is on a part that will admit of being 
bandaged, these two means, used in conjunction, will rarely 
fail to give speedy relief and prevent suppuration, which is 
always a troublesome circumstance ; when it does occur, no 
better application can be made than the bandage, kept satu- 
rated with whiskey. But as soon as the fever is broken 
up, and a good capillary action permanently established by 
a continued use of the syrup, suppuration will be arrested, 
and coagulable matter secreted instead of pus, by which 
the cavities will be quickly obliterated. 

I will close this long article after detailing one case of a 
most malignant character, which was successfully treated 
upon the above plan. The subject was a degraded female, 
who had used intoxicating liquors to great excess for many 
months. When I saw her, the greater part of one leg, and 
a part of the other, were involved in the disease, and vital 
action was so low that an immediate death of the structures 
involved followed the extension of the disease, the surface 
over which it had spread being absolutely black and per- 
fectly insensible ; her pulse was exceedingly feeble and 
threaded, and extremities quite cold; and all this had taken 
place in a few hours. I drove to my office to obtain the 



ERYSIPELATOUS FEVER ERYSIPELAS. 229 

necessary remedies, and a severe shower of rain prevented 
my return for about two hours. By this time the disease 
had made its appearance on the abdomen; an extent of 
surface larger than a common saucer, just below the navel, 
was of a deep mahogany color. I looked upon the case 
as desperate, but concluded to make an effort. I gave her 
the fever syrup in tablespoonful doses, every hour, with 
ten grains of carb. ammonia in each dose ; cloths saturated 
with chloroform liniment were applied over the affected 
surface, and extending beyond its boundary. I called next 
morning, and I confess was much surprised to find her not 
" only alive, but doing well ;" the disease had not extended; 
pulse full and natural, and extremities warm ; nothing more 
was done, except that the syrup was continued at longer 
intervals, and cloths over the affected surface kept wet with 
whiskey. In a few days the dead black scarf-skin peeled 
off entire, leaving a sound surface beneath. 

There is a variety of this disease known among the 
people by the name of shingles, which appears on the body 
in irregular patches ; it requires no peculiarity of treatment, 
but yields very readily to the remedies which have been 
described. Still another variety, which usually assumes 
an irregular circular form, is known as the rose; it also 
yields to the same treatment. 

The external actively inflammatory variety, which is the 
most common form in which this disease is seen in this 
country, is known as St. Anthony s Fire ; and the epidemic 
form which it assumed some years since, in which capillary 
action is so low as to allow of an almost total stagnation of 
blood in them, giving a black or dark mahogany color, 
has received the name of black tongue. The deep-seated 
variety, which is not so readily recognized by the eye, 
is usually known as phlegmonous erysipelas. 

I had thought of giving the treatment recommended by 
other writers on this disease, but, as I think it would only 
confuse the reader, I omit it. 



230 on fever: 



DIPHTHERIA. 

When this disease presented itself in the United States 
in an epidemic form, some years since, it was thought to 
be a new disease; but the wise man's declaration that 
" there is nothing new under the sun" applies in the pres- 
ent case, for medical records show that from the earliest 
period of the world's history down to the present time 
this disease has occasionally paid its unwelcome visits, 
and often made the nations tremble with fear. We owe 
much to Dr. J. L. Madden, of Nashville, for an able and 
exhaustive paper, which he read before the State Medical 
Society last April, upon this subject, and by his permis- 
sion it will be drawn upon rather freely in the preparation 
of this chapter. Now, although it is certain that diphthe- 
ria has occasionally prevailed as an epidemic, in different 
countries and at various times, ever since "sin entered 
into the world," yet it was never known by this name 
until within comparatively a recent period, but was recog- 
nized by different names at different times and in different 
countries. We will not tax the reader with its history, 
but proceed at once to consider its nature, and designate 
the best mode of treating it at present known. 

As diphtheria often prevails as an epidemic, it might be 
expected to be a disease of low vital action; and observa- 
tion proves this to be eminently true, it in some instances 
overwhelming the system so entirely that the patient dies 
in the first stage, without the occurrence of any of the 
distinctive features of the disease, as we see occasionally 
the case in cholera, scarlatina, and other malignant epi- 
demical diseases. But usually, after a period of a day or 
two of indisposition common to all febrile diseases, it man- 
ifests- itself by symptoms much resembling those of the 
first stage of scarlet fever, such as huskiness of the voice, 
some soreness and swelling of the throat and of the glands 
about the throat and neck, some increased discharge from 
the throat and nostrils, as in common colds, etc. On ex- 
amination there will now be seen increased redness and 
thickening of the mucous membrane of the mouth and 



DIPHTHERIA. 231 

fauces, and the uvule, or pendulous palate, and the tonsils 
are enlarged and much congested, giving them rather a 
livid or mahogany hue. The tongue is furred, and the 
whole inside of the mouth looks slimy. There is now 
some fever, but the heat is not apt to be great; the skin 
may be dry and harsh, but is most likely to be irregularly 
moist and dry, and feels doughy. In this stage it may 
easily be mistaken for scarlet fever; in fact, we will have 
to be governed a good deal by the prevalence of either 
disease at the time in making a diagnosis. But a mistake 
will lead to no injurious results, as both may be properly 
treated in the same manner in this stage; tfyat is, they 
should be let alone, merely keeping the patient within 
doors, covering as warmly as is consistent with comfort, 
and giving warm, bland drinks, as sage, balm, or catnip 
tea. As diphtheria is decidedly a disease of low aciont — 
that is, it is attended by diminished nervous power, so 
that nutrition is suspended or greatly crippled, there not 
being sufficient vital energy to convert dead into living 
matter, so that, although the patient may have some appe- 
tite, and digest well so far as the stomach is concerned, 
yet when the material comes to the point of transforma- 
tion from dead to living matter the power is insufficient, 
and it is either thrown off by the kidneys, giving rise to 
albuminuria, or it may be thrown off in the form of a mor- 
bid secretion from the bowels, causing watery and albu- 
minous diarrhea, very similar to and originating from a 
like cause as the rice-water discharges in cholera — there- 
fore it becomes essentially necessary to attend to this con- 
dition at once, and use every means available to increase 
nervous power, prevent the waste from the system, and 
support the general strength until the disease has had 
time to run its course. With this idea kept prominently 
in view the proper regimen will at once present itself to 
the mind of any intelligent person, such as plenty of fresh 
air, frequent changing of the apparel and bed-clothes, cold 
water drank at will and applied several times a day to the 
whole surface by sponging, taking care not to expose 
much of the person to the air at a time, but sponging one 



232 on fever: 

limb after another, then the front and afterward the back 
of the trunk or body, always rubbing the surface dry with 
a flannel cloth. But, should cold feel unpleasant to the 
patient, it should be changed for hot water. I say hot, for 
it must not be lukewarm, as that is most decidedly debili- 
tating. It should always be used cold, or hot enough to 
make an impression; and it is well that the reader should 
remember this, as it will apply in all cases of disease of a 
low order. There is very little difference in the effect 
produced by hot and cold applied to the surface; both 
stimulate, and I always use that which feels most agree- 
able to the patient. Another thing it will be well to 
remember, that when a patient is suffering from thirst 
occasioned by dryness of the mouth and throat, hot 
drinks will allay it more completely and for a longer time 
than cold drinks; the reason is that heat increases the 
natural secretions from the mucous membrane, and cold 
has a tendency to check them, so that when a person is 
parched with fever a swallow or two of tea or simple 
water, taken as hot as the patient can swallow it, will 
much more effectually allay the tormenting thirst than 
any quantity of cold drinks; and in this way the stomach 
is saved from the disagreeable sensation of fullness that a 
free indulgence of cold water will occasion. Thirst will 
also be greatly relieved by the sponging recommended; it 
does this both through sympathy between the surface and 
internal parts, and also by being absorbed and carried 
into the circulation. Another effect of the want of nerv- 
ous power, and consequent failure in the perfect elabora- 
tion of the nutrient material for entering into and making 
part of the living tissues, is that the imperfectly vitalized 
matter is deposited in the glands, causing morbid enlarge- 
ment; and as the vitality is too low to continue the life of 
this material for any length of time, it soon breaks down, 
and, becoming a foreign substance, causes suppuration of 
the glands, and as there is not sufficient power to set up 
the reparative process, the ulcers are exceedingly difficult 
to heal, as in typhoid and other low fevers, deep-seated 
erysipelas, scrofula, etc. This imperfectly vitalized mate- 



DIPHTHERIA. 233 

rial is also, in this disease, often deposited in the substance 
of the kidneys, causing great functional derangement, and 
may go so far as to disqualify them from performing their 
office, and, by leaving the uric acid in the blood, cause it 
to become an active poison, producing death by bringing 
on convulsions or coma, the patient presenting much the 
same symptoms as would be caused by an over-dose of 
opium. 

This same badly elaborated material enters into and 
chiefly composes the morbid exudation that is thrown out 
upon the mucous lining of the mouth and air passages, 
which forms the most distinctive feature of this disease, 
and has given it its name. At first this presents itself in 
the form of a slimy and somewhat tenacious coating of 
those parts, but soon appears in distinct patches of a whit- 
ish membrane on the tonsils and roof of the mouth. I 
have seen it present the appearance of white chamois 
leather, with very distinct and abrupt outlines, and look- 
ing as though it might be easily rubbed off; but it adheres 
with great tenacity, and is often actually as firm as leather. 
This false membrane may extend into all the air-passages, 
as the duct leading from the throat into the ear, causing 
partial deafness; into the frontal sinuses, giving rise to 
uneasiness over the eyes, or distress as in sick headache or 
sun-pain; or it may dip into the cavity in the cheek-bone 
called maxillary sinus, and cause painful swelling of the 
face; or it may proceed down through the chink of the 
glottis into the windpipe, occasioning all the symptoms and 
the danger of true membranous croup. This last consti- 
tutes the most dangerous form of the disease, as it may 
speedily cause death by suffocation, by closing the chink 
in the glottis ; for, even should there be no deposit imme- 
diately in that narrow passage, yet if it exists below pieces 
may become detached by coughing and plug up that orifice 
so effectually that the patient may die of strangulation as 
quickly as though choked by a cord. 

The reader will now perceive the importance of sustain- 
ing the vital action of the system above the point at which 
this false membrane is formed, for recollect that the devel- 



234 on fever: 

opment of the material out of which it is manufactured is 
not an essential part of the disease; many cases run their 
entire course without any manifestation of its existence 
except the slimy exudation before spoken of, coating the 
tongue and fauces in the early stage of the complaint, and 
if the simple but efficacious means which have been indi- 
cated be sedulously applied very few cases will ever run 
into that condition in which the blood becomes charged 
with the material of which this adventitious membrane is 
formed. In order that persons having the oversight of 
children should be able to meet this terrible disease with 
appropriate treatment at its very inception, and break it 
up in its forming stage, or hold it in check until the sys- 
tem may become fortified against the occurrence of its 
most formidable symptoms, they should make themselves 
perfectly familiar with the symptoms characterizing its 
first stages, so that no time may be lost, for in this disease 
every thing may depend upon taking an even start with 
the enemy; a very few hours of waiting to see whether 
the case will require treatment or not may give the dis- 
ease such an advantage that no after exertions may be- 
come available in arresting the development of its very 
worst features. 

We therefore insist that, when diphtheria is prevailing 
in the neighborhood, the very slightest manifestation of 
disturbance, common in the beginning of an ordinary cold, 
be met at once with at least this much : Keep the child 
within doors, dress a little warmer than common, keep 
from it all strong or indigestible articles of diet, give mild 
drinks, etc. 

In order to impress it upon the mind of the reader 
we will hastily run over the course of treatment thus 
far recommended : Plenty of fresh air, frequent change of 
clothing and bedding, a free use of bland liquids — taken 
hot or cold, as the patient prefers — frequent sponging of 
the surface with hot or cold water, as feels . best to the 
patient, and friction with dry flannel, and, we will add, as 
much easily digested food as the patient desires; and should 
he not desire sufficient to sustain the system, then give 



DIPHTHERIA. 235 

cod liver oil and whisky, as much as his stomach will tol- 
erate. When my patients express no desire for food at a 
time when I know they should be nourished, I prescribe 
gruel made by boiling cornmeal in water until it is well 
cooked, then add a little fresh butter, and salt and pepper 
to suit the taste. Of this I order two or three tablespoon- 
fuls every two or three hours, with the regularity of im- 
portant medicine, and no medicine is more important. Very 
few patients will refuse to take this, and it always agrees 
with the stomach. But remember you must not ask the 
patient whether he will take it or not, but make it, and 
take it to him, and tell him that I say he must take it, 
and, having once tasted it, he will probably take it with a 
relish. Give no purgatives in this disease, but if the bow- 
els are not moved once in twenty-four hours give the fol- 
lowing: Castor oil and honey each one tablespoonful, and 
whisky two tablespoonfuls; mix well together, and give 
a teaspoonful every two or three hours until the bowels 
are moved; repeat this daily. You may now, in addition 
to the above regimen, give the following: 

R Tincture of the muriate of iron, £ ounce. 

Chlorate of Potash, ........ J ounce. 

Honey, . . . . . . . . . . 4 ounces. 

Decoction of oak or sweet gum bark, or of blackberry root, 1 pint. 
Give a tablespoonful of this every two or three hours, and mop out the throat 
with it several times a day. 

If the disease still proves stubborn and the patient is 
becoming weaker, give quinine and carbonate of ammonia: 

J& Sul. of quinine, . 20 grains. 

Carb. of ammonia, ....... 1 drachm. 

Muriate of ammonia, ...... 2 drachms. 

Honey, 2 tablespoonfuls. 

Water, ......... J pint. 

Give a tablespoonful every two or three hours. 

If there be swelling of the glands about the throat or 
neck, put as much salt in hot vinegar as it will dissolve, 
and saturate a flannel cloth with this, and apply, repeating 
it often. A sock answers admirably, as it fits the neck 
nicely. 

Great care must be taken to avoid a relapse. Some 



236 ON FEVER. 

years ago I attended a very interesting and promising girl 
of ten or twelve years of age, who had a severe attack of 
diphtheria; but, under the mild treatment recommended in 
the first stage of this disease, it yielded very kindly, and 
in a few days she resumed her studies at school; but, after 
having heated herself at play, she was caught in a shower 
of rain, and died the next day of strangulation. 

Quite frequently patients have more or less paralysis as 
a sequence of diphtheria; very often this is confined to the 
organs of speech, sometimes the organs of sense, as see- 
ing and hearing, are affected, sometimes the muscles of the 
neck. But friends need not feel much uneasiness, as I 
have never yet known a case in which the paralysis proved 
permanent. I once attended a sprightly boy of seven 
or eight years who barely escaped death from this disease, 
and for months after recovery he could not articulate in- 
telligibly. His father doted on him, but, in view of this 
affliction being permanent, he regretted that his son had 
not died. I assured him that his child would recover, and 
so he did, completely. I trust alone to time for relief in 
these cases, and it has never disappointed me. 




A BACK VIEW OF THE ADULT SKELETON. 



INFLAMMATION 



Next to fever, inflammation is the most important sub- 
ject that can claim our attention in connection with the 
great subject of diseased action to which the human system 
is liable. A very large amount of the sum of human ills 
has its origin in or is the result of inflammation, either as 
an original affection, or as superinduced in the course of 
other diseases : few cases of fever terminate fatally, except 
as a consequence of inflammation having been set up in 
some important organ. It may, therefore, be justly ex- 
pected that this important subject should receive a very 
careful notice in this work ; and the reader will doubtless 
pardon what would, on a more trivial subject, appear to be 
tediousness on the part of the writer. Now as every 
whole must be composed of parts, these parts must be con- 
sidered separately, in order to obtain any clear idea of the 
qualities or properties or effects of all when conjoined or 
acting together. 

In this way inflammation must be considered in order to 
be understood, and it must be understood as regards its 
causes, its nature, and its events, in order to be success- 
fully managed or controlled ; no person who has never con- 
sidered the chain of morbid action constituting inflamma- 
tion, with reference to each link in its structure, can 
comprehend it as a compound result, or understand even its 
description, much less be able to bring into use the best 
means for its treatment in its various forms and stages. I 
will, therefore, presume that my readers desire that I 
should not merely give the prominent symptoms of particu- 
lar cases, and point out the usual means which experience 

(237) 



238 INFLAMMATION. 

has taught us to use, but that I should also point out and 
explain the condition from which these symptoms arise, 
and give a reason for selecting the remedies which are used 
for their removal ; and I hope that I may succeed in mak- 
ing the subject so plain and interesting, that its study may 
become a pleasure in place of a task. 

Authors have described inflammation as a disease consist- 
ing of increased heat, redness, pain, and swelling. But 
this definition is very imperfect, as it only applies to one 
particular form of the disease ; in other forms, one or more 
of these parts are wanting; for example, in white-swelling 
there is no increased redness, and sometimes no increased 
heat; and in chronic rheumatism, we occasionally meet 
with cases in which there is neither heat, redness, nor 
swelling, and little or no pain, and yet there is inflamma- 
tory action going on in the limb, which is silently altering 
the structures and destroying the usefulness of the member. 
Now a definition of a disease should embrace only that 
which is always present, and without which the disease 
could not exist. I think such a definition can be given. 
When upon the subject of fever, I said that it was, " to all 
intents and purposes, an incipient inflammation :" now 
what constitutes fever ? It is composed of nervous disturb- 
ance and capillary engorgement. What else, then, is neces- 
sary to be added to these to constitute a fully formed case 
of inflammation? It is structural change. Inflammation 
may, therefore, be defined as a disease in which there is 
morbid innervation, capillar?/ engorgement, and structural change, 
and that its most common and prominent phenomena, or 
symptoms, are increased heat, redness, pain, and tumefac- 
tion or swelling. 

We will now take a view of what the microscope has 
revealed as taking place in the formation or getting up of 
a case of inflammation, and see if the above definition be 
correct or not ; it will also serve to instruct us as to the 
intimate nature of the disease, and how the symptoms are 
manufactured that characterize its progress. We will take 
a condensed vieAV of the subject as presented by Bolton- 
brunner. Upon placing the web of a frog's foot under the 



INFLAMMATION. 239 

microscope, he observed that a scratch from a pin, or the 
application of some irritating substance, first caused an 
irregular movement of the blood globules in the capillaries, 
they being pushed on for a space more rapidly than before, 
then stopping, oscillating, or moving back and forth ; then 
taking a backward motion, but finally becoming settled, and 
again pursuing their regular course ; then a period elapsed 
in which every thing seemed to be natural. Now the stage 
of disturbance just described may properly be termed the 
period of excitement, and the time of repose the period of 
incubation, which last will soon be succeeded by other ap- 
pearances, viz. : the blood is seen to suddenly flow into the 
capillaries with unusual force, and these vessels appear to 
contract upon it, so that the circulation is greatly accele- 
rated ; important changes are now seen to take place : the 
blood undergoes a change, or fails to undergo the changes 
that should take place ; the white corpuscles stick to each 
other, and to the sides of the vessels, and a portion of the 
blood is retarded. Now this may be termed the period of 
irritation; but soon the capillaries appear to lose their 
power of action, and suddenly dilate and become engorged 
with blood, which now has a very slow movement, or is 
entirely stationary, or is sometimes seen to even flow back- 
ward ; this is the true period of congestion. Now all this 
may take place, and yet there is no inflammation ; there is 
merely morbid innervation or nervous disturbance, and capil- 
lary debility and engorgement, just such as we have 
throughout the general system in fever, constituting its 
essential elements ; and further, the departure from healthy 
action may here stop, if the cause has been a slight one, 
or if proper means have been used to allay the disturbance, 
and the torpid capillaries again regain their tone and resume 
their proper vital action, by which the blood will again be 
sent forward and the congestion removed. But suppose 
these favorable events do not happen, the next thing which 
is observed to take place is, the fibrin of the blood sepa- 
rates from the other constituents and unites into flakes, 
which, adhering to the little points formed by the white 
corpuscles having stuck to the sides of the minute vessels, 
16 



240 INFLAMMATION. 

fill up their cavity entirely, so that no blood can pass ; the 
most fluid part of the blood, Which is called serum, now 
becomes effused into the cellular or areolar tissue, [the 
loose structure which unites all other parts together,] which, 
with the condensed fibrin and the retarded blood, causes 
hardness, redness, and . tumefaction or swelling ; we now 
have structural change ; inflammation is now fully set 
up ; so we see that nothing but this last movement is 
wanted to convert fever into inflammation ; it is not then 
to be wondered at that inflammation is so often a conse- 
quence of fever. 

Let us sum up what has been said : Inflammation is a dis- 
ease consisting of morbid innervation, capillary debility, and 
structural change ; the first is the direct effect of the cause 
acting upon the nerves, and is manifested by the disturb- 
ance which has -been described in the action of the capilla- 
ries ; the second is partly the effect of the first, for the 
nervous disturbance interferes with the regular supply of 
vital energy which the capillaries constantly require to 
sustain them in the performance of their proper function 
of propelling the blood, and also of performing such changes 
upon it as are necessary to fit it for nutrition, secretion, etc. ; 
consequently, these are badly, or not at all, performed, and 
the blood presents an unusual appearance, and nutrition and 
secretion are suspended in the part, as it is in the same 
condition which obtains in fever. But besides this lack 
of nervous power, the capillaries may be still further crip- 
pled in their action by direct injury received, as mechanical 
injury or excessive irritation. The poison of contagion or 
malaria probably reaches the capillaries, and by its direct 
action tends to bring about this condition ; which accounts 
for the profound congestion which we occasionally see 
attend attacks of fever. 

This much must suffice upon the subject of the elements 
constituting inflammation ; we will now hastily consider its 
progress, its products, its effects, and its modes of termina- 
tion. 

We traced the formative stages of inflammation until we 
arrived at the point of its complete development, resulting 



INFLAMMATION . 241 

in a suspension of the circulation, effusion of serum, and 
consolidation of fibrin ; all of which can be more fully seen in 
phlegmonous inflammation as seen in the common boil, in the 
centre of which we often find a collection of pure black 
blood, which has been poured out by the distended and 
obstructed capillaries, around which we have a dense 
deposit of fibrin, giving the feeling of almost woody hardness, 
and, if cut into, resembles gristle ; outside of this there is 
an effusion of serum which does not give the same feeling 
of hardness, and will even sometimes pit under the pressure 
of a finger ; still outside of this there is some swelling from 
increased fulness of the capillaries. Now, though the cir- 
culation is almost or entirely suspended in the body of the 
phlegmon or boil, it is very much increased around the 
margin ; hence more blood flows to and from the part than 
ordinarily, hence the redness and heat; for in whatever 
way animal heat is generated, it is an observable fact that 
it is always increased by an increase of arterial circulation, 
and in a greater degree when there is an obstruction in the 
capillaries, as in fever and inflammation. The pain is no 
doubt partly the result of heightened sensibility of the 
nerves, occasioned by the action of the cause, and increased 
by the influx of blood, but mostly by the pressure and 
tension occasioned by the swelling ; so that the four most 
prominent symptoms of inflammation have been rationally 
accounted for, viz. : pain, redness, swelling, and increased 
temperature. Now this state of things cannot continue 
long without producing other changes : the part in which 
the circulation is suspended will soon die and become a 
foreign substance, and the absorbent vessels will cut it loose 
from the living tissue ; but the absorbents often proceed 
farther and remove the surrounding living substance also, 
making an irregular cavity ; when they do this, it is called 
ulceration. Sometimes this ulcerative process is salutary, 
as when it proceeds no farther than to remove the interven- 
ing substance between the dead matter and the surface, so 
as to admit of its discharge. Now, as soon as the absorbents 
have cut loose the dead matter, if the constitution be good 
and the surrounding flesh in a healthy condition, ulceration 



242 INFLAMMATION. 

will not take place ; but instead, a mild, tasteless, inodorous, 
creamy-looking matter is poured out from the surrounding 
vessels — this matter is called pus, and the process of its 
formation is called suppuration. This pus is the material 
which first escapes from a healthy boil when it breaks, or 
is opened ; the centre dead part is what is known as the 
core. Sometimes the absorbents are slow in separating the 
core, and it remains firmly attached to the bottom and sides 
of the cavity by shreds of cellular membrane. Now if the 
constitution be depraved, and there is a want of fibrin in 
the blood, as we often find to be the case in scrofula, in 
typhoid fever, and other cases in which the powers of life 
have been greatly reduced, there will not be a sufficient 
amount of this material deposited in the surrounding areolar 
or cellular tissue to prevent the pus which is secreted 
from finding its way into the meshes of this connecting 
membrane, and we will have a diffused tumor ; sometimes 
the pus will in this manner find its way a long distance 
from where it is formed, and may cause much damage. If 
the vitality of the surrounding parts is of a very low order 
when the centre portion of a rising dies, the destructive 
process may extend to the adjacent tissues, and then the 
case will present an example of gangrene, or mortification : 
gangrene signifies a dying condition of parts, and mortifica- 
tion their condition when dead. 

Sometimes an inflammation, after having become fully 
formed, in place of proceeding on to suppuration, ulceration, 
or gangrene, either from a favorable reaction occurring 
spontaneously or brought about by the use of proper reme- 
dies, becomes suddenly arrested in its progress, the capilla- 
ries again circulate the blood, the arteries cease throbbing, 
the pain diminishes, and the absorbents take up the morbid 
deposits and remove the swelling ; this mode of termination 
is called resolution. There is yet another mode in which 
inflammation may terminate — namely, by adhesion, which 
takes place in this manner : Fibrin, or, as it is commonly 
called, coagulable or plastic lymph, when poured out upon 
the surface of a serous membrane, as the pleura, which 
covers the lungs and lines the ribs, or the peritoneum. 



INFLAMMATION. 24 



9 



which envelops the bowels, often glues the surfaces to- 
gether that are in contact or very near each other ; and as 
this substance readily becomes organized by capillaries 
extending into it, these adhesions often remain permanent. 

Inflammation, though generally a serious evil, is in not 
a few instances a very great good ; for example, a sharp or 
jagged body penetrates the flesh, and remains imbedded 
among the tissues in such a position that there would be 
great danger in its removal; it continues to lacerate or 
compress the nerves -upon every motion of the body, giving 
great torture ; but this is not to continue always, for inflam- 
mation is soon set up in the surrounding parts ; a deposit 
of plastic lymph is made in the areolar tissue, which serves 
to form, as it were, a cup to hold the pus which will shortly 
be secreted; the pus surrounds the offending body, and 
separates it from the sensitive tissues ; ulcerative absorp- 
tion removes the structures which intervene between the 
foreign body and the surface, and an opening is thus made 
through which it escapes or may be extracted. But some- 
times, though rarely, this opening is made into an internal 
cavity, which may make the matter worse. In other 
instances, in place of pus being secreted, plastic lymph is 
thrown out, and is formed into a solid covering for the 
offending body ; and as there are no nerves in this newly- 
formed substance, it may remain thus imbedded for many 
years without causing disturbance or inconvenience. Again, 
a wound has been received, and parts divided or torn 
asunder ; if the surfaces are brought nearly in contact, this 
plastic lymph will soon be poured out as a result of inflam- 
mation, and fill up the intervening spaces, and, becoming 
organized, will again make both parts to be but one ; but if 
the cut is made with a sharp instrument, and the sides 
accurately brought together, union will often take place by 
what is termed the first intention ; that is, the vessels from 
the different sides unite so as to carry on the circulation as 
before ; in this way deformities are remedied, as in the 
operation for hare-lip, etc. 

Inflammation differs widely in its symptoms, mode of pro- 
gression, termination, etc., as seen in different structures ; 



244 INFLAMMATION. 

that which has been described corresponds only with it 
when seated in fleshy and sensitive parts, bnt bones, carti- 
lages, fibrous membranes and sinews are all subject to 
inflammation; and as these structures differ widely from 
the muscles, areolar or cellular tissue, mucous and serous 
membranes, etc., with regard to both circulation and sensi- 
bility, the phenomenon presented by inflammation in them 
also differs in a like proportion, being slower in its progress, 
and not so readily running into the stage of suppuration, 
etc., but is more apt to become chronic, and result in altera- 
tions in the structure of the parts ; but as these things will 
come up appropriately when we come to speak of particular 
inflammations, any further comments will be deferred until 
then. Tanner, with whom we principally agree, says : 

The general principles of treatment only admit of being 
laid down. In the commencement, the cause of the inflam- 
mation should, if possible, be removed. Attempts must 
then be made to obtain resolution; or, if this seems im- 
possible, the next best termination, which, in cases of 
external inflammation, will generally be suppuration ; in 
internal, sometimes suppuration, sometimes adhesion. The 
important point then for consideration is this : How are 
these desired results to be best attained ? For very many 
years but one answer has been given to this question, viz. : 
by the adoption of the antiphlogistic regimen ; which con- 
sists essentially in the use of low diet, bloodletting, active 
purging, counter-irritation, mercury, and antimony. It is 
to be feared that these remedies still find favor with some 
practitioners ; but I cannot help thinking that the more 
closely disease is studied, the smaller will become the num- 
ber of the upholders of these antiphlogistic agents. My 
reasons for this opinion are : that when an inflammation is 
established, it is not possible to cut it short ; that bleeding, 
unless carried to a very dangerous extent, will not diminish 
the amount of blood in an inflamed part ; , that bleeding will 
not render an impure blood pure ; that depressing agents 
favor the extension of the morbid action, and deprive the 
system of the power of rallying from the effects of the 
disease ; that in many instances of inflammation there is 



INFLAMMATION. 245 

depressed nervous power, and impaired action of the heart ; 
and that in all cases a lowering plan of treatment is very 
badly borne in the present day. whatever may have been 
the case in former times. 

It is a favorite theory with some pathologists that inflam- 
mation, as we now see it, is of a different type to that 
which formerly existed; perhaps being more readily excited 
by mal-nutrition, being more prostrating, and possibly being 
more dangerous to life, by incapacitating the system for the 
same degree of reaction as that which formerly followed an 
attack. In other words, the febrile symptoms accompanying 
inflammation are said to have altered from an inflammatory 
to a typhoid character. This view has been ably suggested 
by Dr. Alison; though it is well disputed by Professor 
Bennett, who believes that inflammation is the same now 
as it has ever been, that the analogy sought to be estab- 
lished between it and the varying types of fever is fallacious, 
and that bloodletting and antiphlogistic remedies have been 
all along opposed to a sound pathology. As these opinions 
cannot be discussed sufficiently fully in these pages, I would 
especially recommend the perusal of Dr. Alison's and Pro- 
fessor Bennett's very admirable essays to my readers ; 
though, at the same time, I must say that I agree with 
Dr. Bennett. For if Dr. Alison be correct in all his 
assumptions, we must grant that not only the type but the 
cause of disease has changed ; since, if we are to place 
implicit reliance upon the experience of Cullen, Gregory, 
Mason Good, and others, on some points on which they are 
likely to have erred from the imperfection of the means of 
diagnosis, we surely must credit their statements where 
simple observation alone was necessary. Yet, only fifty 
years ago — to take one example from many — inflammation 
of the brain was supposed to be the constant cause of 
insanity ; and at Bethlem Hospital the system of treatment 
consisted of bleeding, purging, and vomiting in the spring 
months. A certain day was appointed in which the patients 
were bled, another in which they were purged, another in 
which they were vomited. They were bled again in May 
and June, the precise time depending on the weather. All this 



246 INFLAMMATION. 

had been the practice for many years, and no better prac 
tice, it was stated, was then known. 

But something more may be said upon the practical 
bearings of the question, i. e., upon the treatment of inflam- 
mation. On this point I think it may be said that those 
practitioners who have the greatest amount of practical 
experience, combined with an extensive knowledge of 
physiology, pathology, and therapeutics, are now mostly 
agreed that our study should be confined to simply attempt- 
ing to guide the morbid process to a favorable termination ; 
just in the same way as we at present try to conduct cases 
of typhus, small-pox, scarlatina, etc., through their natural 
progress, without making heroic and injurious efforts to cut 
short the disease. This object is to be obtained by sup- 
porting the vital powers instead of lowering them, and by 
assisting the excretion of effete products. During the early 
stages of the attack, all sources of irritation should be 
removed, so that the patient may enjoy perfect quiet of 
body and mind ; the sick-room should be well ventilated, 
and kept at a temperature of about 60° Fahr.; the diet 
should be light, and cold water freely allowed ; and if the 
febrile excitement be great, salines in small doses — Formulae 
312, 316, 318, 323, and 327 — may be ordered. When the 
pulse becomes soft, good beef tea and nutrients are to be 
administered ; and directly there are indications of weak- 
ness, we may be sure that wine is required, in quantity 
varying from four to twelve ounces in the twenty-four 
hours. As the period of crisis approaches, Dr. Bennett's 
example may be followed of giving a diuretic — spirits of 
nitric ether half a drachm, with or without ten minims of 
colchicum wine — thrice daily, to favor the excretion of 
urates ; whilst, when a crisis occurs by sweating or diarrhoea, 
care is to be taken not to check it in any way. 

The success of this plan is apparent from the following : 
During the last eight years Dr. Bennett has thus treated 
all the cases of pneumonia which have been under his care 
in the clinical wards of the Royal Edinburgh Infirmary, 
amounting to sixty-five ; of which number sixty-two were 
dismissed cured, and three died; that is, one in 21§. Of 



INFLAMMATION. 247 

tlie sixty-two cases cured, fifty -five were uncomplicated and 
seven complicated ; of fifty-one of the uncomplicated, forty 
were single and eleven double pneumonias, the average 
duration of the former being 14 \ days, and of the latter 
21 days ; while of the seven complicated, one supervened 
on bronchitis and emphysema, two on typhus fever, one 
on bronchitis and pleurisy, one on pleurisy with effusion of 
eight w T eeks' standing, one on rheumatism with heart 
disease, and one on severe rheumatism with endocarditis 
and pericarditis \ the average duration of the pneumonia in 
these seven being 21 3 days. The three fatal cases were 
all complicated : the first, with uncontrollable diarrhoea and 
follicular disease of the mucous membrane of the small 
intestines ; the second, with persistent albuminuria and 
anasarca ; and the third with delirium tremens and universal 
cerebral meningitis. 

When this result is contrasted with that obtained from 
an opposite course of treatment, it seems to me that all 
doubt on the subject must be removed. Thus, during ten 
years — from 1st July, 1839, to 1st July, 1849 — 648 cases 
of pneumonia were treated by different physicians, according 
to the rules then enforced by all writers, in the Royal 
Infirmary of Edinburgh ; of which number 388 w T ere cured, 
38 relieved, and 222 died. Of 107 cases recorded by M. 
Louis in 1835, and treated by bleeding and tartar emetic, 
32 died. So, of 648 cases treated by Rasori, in the hospital 
at Milan, by large doses of antimony, 143 died. Again, 
Laennec, who bled moderately at the commencement of the 
disease, regarded the mortality as one in six or eight. And 
lastly, Dr. Dietl treated 380 cases of primary pneumonia, 
in the Charity Hospital of Vienna, thus : 85 by vene- 
section, one death in five resulting; 106 by large doses of 
tartar emetic, with one death in 5.22 ; and 189 by diet- 
only, with one death in 13i, all the fatal cases moreover 
being complicated. 

At the same time that bleeding as an antiphlogistic 
remedy should be rarely if ever practiced, it may be re- 
membered that a small loss of blood may often be benefi- 
cial, particularly in relieving excessive pain, and in mode- 



248 INFLAMMATION. 

rating attacks of dyspnoea due to some obstruction to the 
circulation in the heart or lungs. As Dr. Bennett remarks : 
"I have often been struck, especially in cases where large 
thoracic aneurisms cause these symptoms, with the small 
loss of blood which will occasion marked relief. The same 
result may be hoped for in other cases where the conges- 
tion is passive, even when that is associated with active 
repletion of blood, followed by exudation. But I need 
scarcely remark, that this mere palliative object of blood- 
letting is not the ground on which the practice has hitherto 
been based, and that in this point of view it requires to be 
very differently explained." The same remarks apply to 
the use of tartar emetic ; which is valuable in small doses, 
and combined with other neutral salts to favor excretion by 
the skin, kidneys, or intestines ; but most injurious when 
employed in the heroic way often recommended. 

With regard to the use of mercury, there appears to be 
every reason to believe that its utility in controlling inflam- 
mation, or in promoting absorption of the effused products, 
has been very much overrated ; and indeed it seems highly 
probable that inflammatory diseases will progress more 
favorably without the use of this medicine than with it. 
Few practitioners, even now, would think of treating peri- 
carditis or iritis without mercury ; yet more than ten years 
have elapsed since Dr. John Taylor's valuable contributions 
to clinical medicine were published, in which it was clearly 
shown that the opinions then current on this subject re- 
quired revision. For example, of the cases on which this 
excellent physician founded his observations, four got well 
without any treatment ; in twelve, ptyalism was not fol- 
lowed by any abatement of the pericarditis ; in six, ptyal- 
ism was followed by pericarditis ; in three, by endocarditis ; 
in two, by extensive pleurisy; in four, by pneumonia; in 
one, by erysipelas and laryngitis ; in one, the pericarditis 
and pneumonia both increased in extent after ptyalism; 
while in only one instance was salivation followed speedily 
by relief, and in two or three by a gradual diminution. 
More recently, Dr. Henry W. Williams has cured sixty- 
four cases of iritis, of every degree of severity, including 



INFLAMMATION. 249 

its idiopathic, traumatic, rheumatic, and syphilitic varieties, 
without a dose of mercury ; the treatment having chiefly 
consisted in sustaining the general system, in relieving pain 
by narcotics, and in keeping the pupil dilated by bella- 
donna. 

From all this it follows that, in the treatment of acute 
inflammatory diseases, practitioners must be content to 
trust more to nature, and less to heroic remedies, than they 
have been in the habit of doing ; for it is highly probable 
that though we may be able to guide inflammations to a 
successful termination, yet we cannot cut them short, and 
any attempts to do so will merely increase the patient's 
danger. \ 

Dr. Watson says in the latest edition of his work : 
"Years have passed since I have seen any instance of the 
disease (inflammation of the lungs) which has required 
phlebotomy. I may say much the same of inflammatory 
diseases in general. They have all, as I firmly believe, 
been less tolerant of bloodletting since the cholera first 
swept over this country in 1832." 

I have thought proper to preface the remarks which I 
shall make upon this subject, by the above copious extracts 
from recent standard authors, in order to break down in 
advance, as much as possible, the prejudice which might 
arise in the mind of the reader against the doctrine I shall 
inculcate, and the practice I shall recommend ; for I am 
fully aware of the difficulty of persuading people that the 
way that they have always seen any thing done, is not the 
best way ; and more especially is this the case when the 
process by which it is done is mysterious, and not easily 
comprehended or understood ; hence, opinions in matters of 
faith are much harder to change than opinions in matters 
of sense; and upon no subject is the prejudice of the 
masses harder to combat, than upon the mode of treating 
disease. Opinions which originated away back in the reign 
of ignorance and superstition, and which the light of science 
has banished from the minds of most of the profession long 
since, are still handed down from generation to generation 
by tradition among the people, and adhered to as the oracles 



250 INFLAMMATION. 

of divine truth. In this way, the absurdities taught by the 
early fathers in medicine are still preserved; and Hippo- 
crates and Aristotle still influence, not only opinion, but 
practice ; and thus the Humoral pathology, with all its an- 
cient absurdities and errors, is still clung to, and made the 
basis of domestic treatment ; and it is precisely this ancient 
error which the recent important change in the treatment 
of fevers and inflammations will find opposing its pro- 
gress, both from a part of the profession itself, as well as 
from the masses. For although a physician of the present 
day would hardly acknowledge that he believed the doc- 
trine, as understood by the ancients, yet he still often 
clings to the notion that disease is a something which enters 
the system — some entity, some enemy which has obtained 
ingress, and must be got out, in order to cure the patient ; 
hence the inveteracy with which they cling to evacuants in 
fever : the fiend or goblin which is raising the disturbance in 
the system must be puked, or purged, or sweated out of the 
system ; or a gap must be let down or opened by the lan- 
cet, and the rascal driven out while swimming in the blood; 
or if the goblin cannot be made to escape by any of these 
ways and means, then he must be poisoned, and arsenic or 
mercury, or some other poison, is exhibited. 

Now I know that this, it will be said, is a caricature ; 
that nobody, and especially no physician, so believes. I 
am sorry that I cannot take back what has been said, for 
then there would be no necessity for argument to sustain 
the position that disease is not a thing, but a condition — not 
something which must be driven out, but a mode of action 
that must be changed — a perverted or irregular motion of 
the machinery of life that must be set right or regulated ; 
and certainly the means that will do this, with the least 
expense to the powers of life, with the least disturbance 
of the vital machinery, must be the best means. It would 
be very foolish to cut away wheels and remove braces, in 
order to get clear of an obstruction, when a little adjust- 
ment of the balance-wheel, or the removal of improper 
friction, will put all to rights without injury to the ma- 
chinery. And wrong or perverted action can be set right, 



INFLAMMATION. 251 

or obstructions which interfere with the performance of the 
vital functions can generally be removed, without loss of 
power, without detriment to the integrity of the system, 
without chopping and scarring, or otherwise marring its 
fair proportions, but leaving it as whole and as sound, and 
as strong to endure, and as capable of performing all the 
beautiful and varied motions constituting health, as before 
any thing went wrong, or had got out of order. 

Now it has been shown in the preceding pages that fever, 
however produced, consists in a certain condition, and that 
the indispensable elements of this condition are morbid 
innervation, or nervous disturbance, and capillary debility, 
and consequent engorgement ; that without these there can 
be no fever, and that with them, in any considerable degree, 
there is, and of necessity must be, fever; and that to 
remove them is to cure the fever, of whatever grade or in 
whatever stage it may be. And we have also just seen, 
that these elements carried a little farther, far enough to 
produce structural change, or alteration of the composition 
of the structures implicated, constitutes inflammation; it 
will, therefore, follow, as a reasonable consequence, that 
the same great principles which should govern us in the 
treatment of fever, should also be observed in the manage- 
ment of inflammation; further, it has been shown that 
by removing the condition in which fever consists, the dis- 
ease is destroyed, and has no further existence, and leaves 
the system as it was before the attack, provided this is 
done before any organic change has taken place in any of 
the vital organs, or other serious damage been sustained. 
The same is also true with regard to inflammation : let the 
condition in which it consists be removed, and the inflam- 
mation is removed ; allay the nervous disturbance, correct 
morbid innervation, and arouse the torpid capillaries, and 
thus remove the obstruction, and, consequently, the con- 
gestion, and there will then be nothing left but the struc- 
tural change, which the natural recuperative and restora- 
tive powers of the system will soon remove or set right ; 
provided the disease has not progressed to the stage of de- 
composition. I therefore differ with Tanner, in regard 



252 INFLAMMATION. 

to the position that inflammation cannot he cured, hut • only 
conducted to a favorahle termination ; as I do with him and 
others, that typhoid fever cannot he cured ; hoth may he cut 
short, hroken up, or aborted, and made to terminate in 
health, without having run through the regular and often 
tedious and dangerous course that they will run if let alone, 
or treated with mere palliatives, and especially if badly 
treated. And now we will come to the main point : How 
can this he done ? It can he very easily done ; so easily, 
and by such simple means, as not to be sufficiently striking 
to gain the attention or secure the credence of the lovers 
of the marvellous, or the admirers of the heroic \ but sober 
and reasonable minds will accept the plan, though it does 
work by small means, and accomplish a great deal with but 
little fuss. 

My readers who have carefully followed me through the 
preceding pages are, I presume, almost prepared to antici- 
pate me, and suggest the treatment themselves. The reme- 
dies are, anodynes, capillary stimulants, emollients, and 
alterants. If there be fever, as the febrile movement is a 
unit, it should be treated as other fevers, viz., give the 
fever syrup, etc. ; but morbid innervation is more intense 
than in fever, and, being more local, is not so easily reached 
by remedies addressed to the general system ; more power- 
ful means will, therefore, have to be resorted to, and more 
stress laid upon the use of topical or local applications. It 
is in inflammation that opium exerts its greatest influence 
over diseased action; given so as to fully impress the 
system, it will often, alone, fulfil all the indications neces- 
sary in arresting inflammation. It soothes and quiets the 
restless, fretted nerves ; arrests the morbid action in the 
nervous centres, from which undue or unnatural nervous 
power proceeds ; and, by its secondary effects, acts as a 
powerful capillary stimulant, and relieves the engorgement, 
without which inflammation cannot exist. But, in order to 
insure success, it will often be necessary to administer 
opium, or its preparations, in doses large enough to satisfy 
even the lovers of the heroic; but we will speak of this 
more specifically when we come to treat of particular inflam- 



INFLAMMATION. 253 

mations. Nothing original is claimed for the use of opium 
in inflammation ; it has long been used for allaying the pain 
and other distress attending this disease ; and, recently, has 
been relied on, to a considerable extent, as a principal 
remedy ; but I will endeavor to point out more accurately 
than has before been done, what we may expect from its 
use, the manner of its action, and how to graduate the dose, 
so as to produce the precise effect desired, without danger 
or injury to the system. The next indication is to excite 
capillary action ; the best internal means for accomplishing 
this is the fever syrup, given in conjunction with opium ; 
but much may be accomplished by local remedies, which 
should combine strong stimulant with anodyne properties ; 
nothing, however, has produced such decisive effects in my 
hands as the chloroform liniment ; but equal parts of cam- 
phor, turpentine, and laudanum do pretty well ; or turpen- 
tine, laudanum, and spirits of hartshorn. I have repeatedly 
aborted local inflammation by these means alone, if applied 
early — have often even cut short the progress of an ordinary 
boil, after considerable swelling and great hardness had 
taken place, and the stage of suppuration was evidently 
near at hand, by saturating a pledget of cotton or lint, or a 
piece of soft rag folded several times, with the chloroform 
liniment. The smarting is intense for about a minute, 
when the chloroform begins to have its effect, and all suffer- 
ing suddenly ceases. If the boil was greatly congested in 
the centre, and had commenced softening preparatory to 
forming an abcess, the liniment would cause the half dis- 
organized blood and serum to escape through imperceptible 
openings in the skin, and the boil would presently shrink 
and disappear. I have, in this way, cured in a very short 
time what is known as blood-boils, which are generally slow 
in coming to maturity, and very apt to leave an ugly scar, 
which, on the face of beauty, is no small calamity ; this the 
liniment prevents by causing the blood to escape, as we 
said, through imperceptible openings, or by arousing the 
absorbents and exciting them to take it away, and thus 
leave a whole skin. But still another means may be used 
with great advantage, especially in the most active stage of 



254 



INFLAMMATION. 



inflammation ; I mean emollients and refrigerants, [produc- 
ing cold;] for recollect, that notwithstanding the capillaries 
immediately concerned in inflammation are in a state of 
torpor and passive congestion, yet, outside of these, and 
often mingled together, these vessels are in a state of 
excitement and are the seat of active congestion; that is, 
they act vigorously in propelling the blood, but many of 
their mouths or terminations are the seat of spasm, which 
prevents the blood from flowing on smoothly; hence the 
scarlet redness of the margin of a phlegmon or boil — hence, 
also, the throbbing and much of the pain. Then, again, the 
parts in which the phlegmon may be seated may be of an 
unyielding nature, at least give way with great difficulty 
under the pressure of the causes that produce swelling; 
and, by this means, compress the nerves, so as- greatly to 
increase the pain. Now emollients, such as flax-seed or 
slippery-elm poultices, by their fourfold action of soothing 
iritation, relieving spasm, relaxing fibres, and lessening heat, 
act a very important part in the relief, and aid much in the 
absolute cure, of inflammation. Now, as cold and moisture 
possess nearly all the valuable properties of the emollient 
poultice, they may often be used instead, either as a change, 
or when the poultice is not easily obtained, or is difficult of 
application from the peculiarity of the seat of the disease ; 
they are best applied by saturating cloths in cold spring or 
ice-water, and renewing them as often as they become 
warm. 

But it may be inquired, How are these external remedies 
to be brought to bear upon deep-seated and internal inflam- 
mations ? I answer, by repeating what I said on a former 
occasion, that the beneficent Author of our existence formed 
us so that there exists an intimate relation, a close sym- 
pathy, between internal parts and the external surface 
immediately opposite or over them ; and this is the case, to 
nearly or quite as full an extent, between organs which are 
entirely free from the adjacent external walls, and have no 
peculiar dependence of function upon the opposite external 
surface, nor any nervous connection but that which is gene- 
ral, and exists through the medium of the origin of nerves 



INFLAMMATION. 251 







from the one great chain, composed of the brain, spinal 
marrow, and great sympathetic nerve and its little brains, 
or ganglia. But however mysterious this sympathy may 
be between the external surface and opposite internal parts, 
we know it exists, and physicians have all along availed 
themselves of its advantages in the treatment of internal or 
deep-seated diseases. 

I have said, in another place, that a law governing the 
sympathies which exist between unconnected or distant 
parts is, that the same kind of impression which is made 
upon an associating part, is also made upon the part with 
which it sympathizes ; this provision enables us to obtain 
almost as direct access to, and exert as much control over 
parts which are "not seen" as upon "those which do 
appear." « 

But in this state of existence we rarely enjoy a good 
without its forming a door through which evil may also enter : 
now many of the internal inflammations which we are called 
to treat have been produced by morbid impressions made 
upon the external surface, or upon an associating organ, as 
protracted cold and moisture upon the surface, inflammation 
of the parotid gland, [gland below the ear,] upon the breasts 
of females, or acting upon the breasts of ladies dressed for 
parties, upon the uterus, causing obstructions, etc., etc. 

We have now taken a hasty view of inflammation with 
regard to its intimate nature, its phenomena or symptoms, 
and their cause, the manner of its progress, and its results 
or terminations ; we have also considered the philosophy of 
its treatment, and suggested the remedies which have in 
our hands, and in the hands of others, proven most suc- 
cessful, and explained very briefly the modus operandi or 
manner of acting of these general remedies ; it now remains 
that we take up individual or particular inflammations, and 
point out their symptoms by which they may be known 
or recognized, called diagnosis, then notice its causes, and, 
lastly, suggest the amount and variations of treatment which 
each case requires in order to abort or to cure it, or lead it 
to the most favorable termination. 
17 



256 



INFLAMMATION. 



CHAPTER I. 

PARTICULAR INFLAMMATIONS 



PLEURITIS, OR PLEURISY. 

Inflammation of the pleura is selected for our first con- 
sideration, because it will admirably serve as a type of 
inflammation involving any other serous membrane, and 
because its treatment will serve as a basis for the treatment 
of all inflamed serous surfaces, and pretty well for all 
other cases of active inflammation, and so may serve to 
prevent much tedious repetition. Most persons are familiar 
with this disease, and Avould be able to recognize it without 
any description ; but as its symptoms serve to point out the 
stage of the disease and the alterations which are going on 
which require particular treatment, we will therefore take 
a general view of its phenomena. 

Symptoms. — The disease is ushered in with rigors, fol- 
lowed by fever, and an acute lancinating pain in the side, 
called a stitch ; which pain is aggravated by the expansion 
of the lung in inspiration, by coughing, by lying on the 
affected side, and by pressure. There is also a short, harsh 
cough, the skin is hot and dry, the cheeks flushed, the 
pulse hard and quick, and the urine is scanty and high- 
colored. If we listen to the painful part of the chest at 
this period, we shall hear the dry inflamed membranes, the 
pulmonary and costal pleurae, [membrane covering the lungs 
and lining the ribs,] rubbing against each other, and pro- 
ducing a friction sound ; if the hand be placed on the corre- 
sponding part of the thorax, [chest,] this rubbing may also 



PLEURISY. 257 

be felt. But the sound soon ceases : either the inflamma- 
tion terminates in resolution, and the two surfaces of the 
pleura regain their natural moisture and smoothness ; or, 
the roughened and inflamed surfaces become adherent ; or 
they become separated by the effusion of serum, and a kind 
of dropsy results, known as hydrothorax. If the pleurisy 
has been severe, the effusion becomes excessive ; (it may 
vary from an ounce to several pints ;) and the fluid accu- 
mulating in the sac of the pleura compresses the yielding 
lung^ suspends its functions, displaces the heart, and some- 
what distends the thoracic parietes, [walls of the chest.] 
When the serous fluid is mixed with pus, the disease is 
termed empyema. If we listen to the chest now, we shall 
find the respiratory murmur diminished, in proportion to 
the quantity of fluid thrown out; where this is excessive 
and the lung is compressed backwards, flattened almost 
against the spinal column, no vesicular breathing at all will 
be heard, but instead we shall hear the air passing into the 
larger bronchial tubes, the condensed lung and the layer of 
fluid acting as conductors of sound ; we then say that bron- 
chial respiration, and bronchial voice, or bronchophony, exist. 
The bronchophony may be accompanied by a tremulous 
noise, resembling the bleating of a goat ; it is then termed 
cegophony. If the lung be completely compressed, so that 
no air can enter even the bronchial tubes, then no sounds 
of any kind will be heard ; but on the healthy side the 
respiration will be more distinct than natural, will be puerile. 
There will also be dulness on percussion all over the affected 
side, if the pleura be full of fluid ; if it be only partially 
filled, we can judge of the quantity by placing the patient 
in different attitudes ; for since the fluid will gravitate to 
the most dependent part of the cavity, so it will carry the 
dull sound with it. We shall also often be able to judge 
of the amount of the effusion by the dyspnoea which the 
patient suffers ; since this will, of course, be most urgent 
when the lung is most compressed. At the same time, 
also, the sufferer is unable any longer to lie on the sound 
side; clearly because the movements of the healthy lung 
would be impeded by the superincumbent weight of the 



258 INFLAMMATION. 

dropsical pleura. The pain, moreover, no longer prevents 
his lying on the diseased side. If we measure the two 
sides of the chest, the side containing the effusion will be 
found the largest; we must remember, however, that in 
many persons the right half of the chest is naturally rather 
larger than the left. 

After a time the symptoms begin to decrease, and absorp- 
tion of the effused fluid commences. Supposing the lung 
to be bound down by adhesions, it will not expand in pro- 
portion to the absorption of the fluid ; the affected side will 
then shrink inwards, and, instead of any longer remaining 
larger than the sound side, will become smaller. 

Causes.— The most common causes of pleurisy are ex- 
posure to cold and wet. In cancer of the female breast 
pleurisy often occurs secondarily, either from the irritation 
of the pleura by a deposit of cancer beneath it ; or in some 
instances, probably- — as Dr. Walshe suggests — by the sub- 
inflammatory action on the confines of the diseased gland 
extending through the intervening tissues to the pleura. 
And, lastly, mechanical injuries will excite inflammation of 
the pleura. Thus the jagged ends of a fractured rib often 
give rise to it; while if they also wound the pulmonary 
pleura, air will escape from the lung into the pleural cavity. 
The presence of air in the pleura may also be due to other 
circumstances : thus it may arise from an external wound ; 
or from ulceration from the extension of a tubercular cavity. 
When the pleura contains air alone, we say there is pneu- 
mothorax ; when, as generally happens, there is a liquid 
with the air, we call the disease pneumothorax with effusion. 
The physical signs of pneumothorax are great resonance 
on percussion, with indistinctness of the respiratory mur- 
mur on auscultation; the patient's breathing, cough, and 
voice giving rise to a ringing metallic noise like that pro- 
duced by blowing obliquely into an empty flask, and hence 
called amphoric resonance. When there is also liquid with 
the air, we obtain in addition a sound known as metallic 
tinkling ; which results from a drop of fluid falling from the 
upper part the cavity and causing a little splash. 

Treatment. — The indications in the treatment of pleurisy 



PLEURISY. 259 

are, first, to subdue the inflammation ; and, secondly, to pro- 
mote the removal of its products. As, probably, the more 
the patient is lowered, the more severe will be the results 
of the inflammation, I would advise the practitioner not to 
resort to bloodletting ; but rather to trust to the adminis- 
tration of opium in full doses, while hot fomentations are 
sedulously applied to the inflamed side. When the pain is 
very severe, the removal of a couple of ounces of blood by 
cupping will possibly give relief sooner than any other pro- 
ceeding, by unloading the congested vessels. But even 
before taking away this small quantity, it will be better to 
try the fomentations, together with dry-cupping. If the 
practitioner have any faith in the powers of mercury to 
control inflammation, he may administer calomel and opium. 
The bowels should be kept open by purgatives, if necessary ; 
the diet should consist of gruel, arrowroot, and broths ; and 
cooling, refreshing drinks are to be allowed. 

If these means prove insufficient, and effusion takes place, 
we then endeavor to promote absorption. The patient 
must be kept on a moderate diet, free from stimulants ; a 
succession of blisters should be applied to the diseased side ; 
and purgatives and diuretics administered. — Tanner. 

The above is good treatment so far as it goes, but it will 
often fall short of being sufficient to arrest the disease 
before effusion and suppuration take place ; which should 
be accomplished if possible, as they greatly protract the 
sufferings and confinement of the patient, and often lead to 
fatal results — either directly, by compression of the lungs, 
or indirectly, by setting up diseased action in the lungs 
which may terminate in consumption. I would therefore 
recommend, that in addition to a free use of opium — say 
from two to four grains repeated every two or three hours, 
until a decided impression is made — the fever syrup also 
be given in doses of a tablespoonful between each dose 
of opium ; as soon as the patient becomes fully impressed by 
opium, which may be known by the pain becoming less, 
breathing longer and deeper, and moving the ribs a little, in 
place of breathing entirely with the diaphragm and abdo- 
minal muscles, and especially if there should be itching of 



260 INFLAMMATION. 

the nose, and a feeling as of flies lighting on the face, the 
use of opium should now be suspended and need not again 
be resumed, unless a return of the pain demands it; sul. 
morphine may be used instead of opium, only using a third 
of the quantity. Dover powder, I think, is usually prefer- 
able to either ; it must be given in five or six grain doses ; 
or if opium or morphine is preferred, and the surface is hot 
and dry, a grain of tartar emetic, or two grains of ipecac, 
should be put into a glass of water, and a tablespoonful 
given every half hour. In addition to the hot cloths recom- 
mended by Tanner, I have the whole chest freely bathed 
with chloroform liniment; this often acts like a charm in 
relieving the stitch in the side, and otherwise quiets the 
patient, so as to generally render it unnecessary to repeat 
the opiate. If these means should fail to give decided 
relief in six or eight hours, I at once apply a fly-blister, 
and cover it with the hot cloths to hasten its action. I 
don't think it proper, as Tanner appears to do, to wait for 
effusion or suppuration to take place, but anticipate these 
events and prevent them ; and the above course will pre- 
vent them, if it be commenced but a few hours ahead 
of the occurrence of these untoward events. Hecollect you 
must apply a large blister, and repeat the application of the 
hot cloths every half hour at least, and let the blister 
remain until the cuticle has risen into small blisters, then 
remove it and apply a poultice of mush well greased ; the 
mush should be made thin — thin enough to run — and poured 
on a large cloth, and spread out sufficiently large to cover 
all the affected side. Now, while it is hot, apply lard 
plentifully; it will be easily spread; you can't spread it 
well on a cool poultice unless it is first melted. The lard 
serves not only to keep the poultice from drying and stick- 
ing to the surface, but it has a soothing effect upon the 
blister, and, I think, aids in subduing the disease. At the 
time the blister is applied, a full dose of an opiate should 
be given, so as to keep the patient quiet while it is drawing, 
and, by blunting the sensibility, prevent the nervous excite- 
ment which is often caused by the drawing of a blister, and 
does much injury. But if a decided opiate is given when 



PLEURISY. 261 

it is applied, and the greased poultice prepared and put on 
right, the blister will cause very little suffering, and will be 
powerful for doing good. 

Is it possible, says an old friend, that you will presume 
to cure pleurisy, and neither bleed, nor puke, nor purge ? 
It is possible, my dear sir or madam ; and I will not expect 
to cure it only generally, but will cure it always, if effusion 
has not taken place before I have time to bring my remedies 
to bear upon the case ; and you can do it too : the course is 
a plain one, and need not be blundered in. But the great 
difficulty is, I fear you will not pursue the course long- 
enough to see whether it will cure or not, but will resort to 
the old plan of depletion. The old plan has not always suc- 
ceeded ; we have heard of many lives being lost by pleurisy 
treated thus, and many cases of consumption developed by 
it ; but I am aware that want of success does not always 
bring a remedy or physician into disrepute ; it frequently 
does the contrary : it makes the doctor talked about, and 
kind friends say of the case, that it was a terrible one ; that 
the doctor did every thing that man could do ; he bled and 
re-bled, puked and purged, gave ever so much calomel and 
constant doses of tartar, and, just before the patient died, 
had a blister put on as big as a child's apron ; but the 
man's time had come, and he went in spite of the doctor. 
Well, it was the way his father went, and the doctors bled him 
until the blood would not stain a sheet, but still he went. 

Now this reminds me of what I once heard a distin- 
guished professor tell. He said that, when a beginner, he 
was called to see a sick child in a family which had a long- 
time employed the same physician ; the child rather lingered, 
and the mother concluded it would die, and suggested to 
the doctor that she would like her old doctor to be 
sent for; she did not suppose he could do any good, 
but it seemed so natural to have him about when any 
of them were bad off; that he had attended on her poor 
father and mother when they died, and on her two dear 
little children that had gone, and she would feel bad if 
this child should die without his being there. "Well, 
madam," said the young doctor, "I don't want him here; if 



262 INFLAMMATION. 

lie is not unskilful, he is, at least, unlucky, from what you 
say ; and as I do not intend this child to die, we will have 
no use for him ;" and they did not send, nor did the child 
die. And thus it is that people will hang on to the same 
unlucky doctor, and the doctor to his unlucky means, 
though the grave is glutted with victims ; but their time had 
come, and people do not live always, etc.; but it appears 
from statistics, that when a patient has pleurisy or pneu- 
monia, his time will be five times more likely to come 
if he be treated by depletives, than it will if the doctor 
does nothing but look on, and let the disease rip. 

CARDITIS, OR INFLAMMATION OF THE HEART. 

As inflammation of the heart and its appendages presents 
many of the symptoms of pleurisy or pneumonia, and most 
commonly occurs in conjunction with one or both of these 
diseases, it is often very difficult to diagnose it, or point 
out the symptoms which will determine its presence or 
absence ; and as the treatment is precisely the same, it is 
of little consequence whether the inflammation be known 
as involving the heart or the lungs only, or its investing 
membrane, or only the pleura, or whether both are impli- 
cated. I might therefore properly enough omit any descrip- 
tion of this disease, as many other writers have done, and 
especially as many terms are obliged to be used not under- 
stood by the common reader ; but as some may be curious 
in making distinctions, and would like to have every disease 
described, whether leading to practical advantage or not, I 
will gratify them by copying, pretty much entire, what 
Tanner says upon the subject, as he is briefer and more ex- 
plicit than any other writer I have seen upon this subject. 

PERICARDITIS, OR INFLAMMATION OF THE EXTERNAL SEROUS 
COVERING OF THE HEART. 

Causes. — It frequently arises from acute rheumatism, 
from the contaminated state of the blood produced by renal 
disease, from damp and cold, and from mechanical injuries. 
Dr. Ormerod reduces all cases of pericarditis to two classes : 
1. Rheumatic pericarditis; 2. Non-rheumatic pericarditis. 



PERICARDITIS. 263 

In the first, the disease is always well marked, it is asso- 
ciated with affections of the joints, women appear rather 
more subject to it than men, and it is rarely directly fatal ; 
in the second, the inflammation occurs at a later period of 
life, is most common in men, occurs most frequently in bad 
constitutions, and is very often fatal. 

Symptoms. — These are high fever; pain referred to the 
region of the heart, often darting through to the left scapula, 
[shoulder-blade,] upwards to the left clavicle [collar-bone] 
and shoulder, and down the arm; violent palpitation, the 
motions of the heart being tumultuous, and perceptible at a 
distance from the patient ; irregularity of the pulse ; hurried 
respiration ; incapacity of lying on the left side ; strong 
pulsation of the carotids ; anxiety of countenance ; and 
frequently noises in the ears, giddiness, and epistaxis, 
[bleeding at the nose.] As the disease advances, there is 
extreme debility, cough, suffocative paroxysms, occasionally 
a tendency to syncope, [fainting,] and oedema of the face 
and extremities ; the heart's action also becomes much 
weaker, the impulse irregular and trembling, and the sounds 
weakened and altered in character. In severe cases indica- 
tions of disturbance of the nervous centres frequently show 
themselves ; especially great restlessness, distortion of the 
features, tetanic spasms, and delirium. All these symptoms 
often vary much in different cases ; thus, as Dr. Hoj)e has 
remarked, if the effusion which results from inflammation 
consists almost entirely of coagulable lymph, or if the serum 
thrown out has been rapidly absorbed and adhesions early 
effected, the circulation will be less interfered with, and less 
suffering will result, than in those more formidable cases 
where there is a copious fluid effusion painfully distending 
the inflamed membrane, pressing upon the heart, and 
embarrassing its movements. 

On practicing auscultation, we shall find, in the earliest 
stages, increased intensity of the natural sounds ; if endo- 
carditis coexists, as it so frequently does, a loud systolic 
bellows-murmur will also be heard. Very early, too, a 
distinct alternate rubbing or a to-and-fro sound, as Dr. Wat- 
son terms it, will be audible. The bellows-sound indicates 



264 INFLAMMATION. 

fibrinous deposits in the texture as well as en the surface 
of the valves, from inflammation of the internal membrane 
of the heart, the endocardium, and it generally continues 
for life. The to-and-fro sound is indicative of inflammation 
of the pericardium, and it generally ceases in a few days 
when this membrane becomes adherent to the heart, as it 
always does if the patient survive. When copious effusion 
takes place, we shall have dulness on percussion over a 
larger surface than in health ; if the fluid does not become 
absorbed, we say that hydro-pericardium exists, which 
usually proves fatal. 

If we classify the physical signs of pericarditis, they will 
be as follows : 

1. Sensations of friction communicated to the hand. 

2. Friction-sounds: the "attrition murmurs" of Hope. 

3. Extension of dulness over the heart, resulting from 
liquid effusion. 4. Friction signs, attended with, or pre- 
ceded by, valvular murmurs. 5. Signs of eccentric pressure 
analogous to those of empyema. 6. Signs of excitement 
of the heart. 7. Signs of weakness or paralysis of the 
heart. 

Prognosis. — Pericarditis, especially the rheumatic variety, 
is not so much to be feared for its immediate danger as 
for the traces of permanent injury which it leaves behind. 
The endocarditis which so frequently accompanies it, espe- 
cially produces mischief to the valves of the heart. Hence 
an individual, after apparent recovery, seldom becomes as 
strong as he was before the attack ; he suffers occasionally 
from cough and shortness of breath, and from palpitations 
of the heart on moderate exertion. Sometimes the symp- 
toms remain latent for a few years ; that is to say, they 
are not appreciable to the patient, who flatters himself that 
he is free from all traces of his attack. But after a time 
— much shorter in those who have, to work hard for their 
daily bread, than in the well-to-do members of society — 
the health begins to fail : the weakness, difficulty of breath- 
ing, and palpitations return; dropsical symptoms set in; 
or perhaps another attack of inflammation takes place, and 
proves fatal. 



PERICARDITIS. 265 

Treatment. — In no disease was the lancet used with a 
more unsparing hand, only a few years since, than in inflam- 
mation of the pericardium. More extended experience 
has shown us, however, that this heroic and sure method, 
as it was deemed, of extinguishing the morbid action, is 
not only uncertain, but often very dangerous. Then we 
were also taught the great importance of rapidly getting 
the system under the influence of mercury after bleeding. 
Yet when we look to the authorities of the present day, 
what do we learn ? The question is well answered by Dr. 
Markham, who says : " We find one of the most observant 
and practical physicians amongst us admitting that the 
firm faith which he himself once reposed in the efficacy of 
this remedy, has been undermined by the truth-telling 
effects of further experience." The remarks already made 
on the use of mercury in inflammation quite confirm this 
opinion. 

The treatment which I adopt is that practiced by many 
for the relief of acute rheumatism; the two principal 
remedies being opium and the vapor bath. From these 
agents I believe that I have seen the greatest benefit ; and 
certainly in no instance have they been prejudicial. They 
give great relief to the patient's sufferings, without inducing 
debility; and they in no way complicate the symptoms. 
The quantity of opium which will be needed will vary with 
the severity of the pain and restlessness ; but usually full 
doses, one grain, every three or four hours, will be wanted. 
Sometimes one vapor bath suffices : in other cases, it is 
necessary to repeat it daily, for three or four times. Alka- 
line drinks will also do good. 

In most cases it will be necessary to administer a few 
doses of some purgative; the neutral salts will generally 
agree well. At first the nourishment should be light, con- 
sisting of gruel, arrow-root, and mutton broth. Directly 
the strength begins to fail, however, the diet must be more 
strengthening; and milk, strong beef-tea, and wine freely 
allowed. Dr. Stokes states that he is convinced patients 
are often lost from want of stimulation at the proper time ; 
and he directs us to give support directly the pulse becomes 



266 INFLAMMATION. 

feeble or intermittent, or the jugular veins [veins of the 
neck] become turgid, or pallor and coldness of the surface 
set in, or a tendency to faint upon exertion is manifested. 
" It may be laid down as a general principle that there is 
no local inflammation whatever, the mere existence of 
which should prevent the use of wine, if circumstances 
require it. In two cases especially, namely, cerebritis [in- 
flammation of the brain] and pericarditis, we find the 
greatest timidity in practice with respect to the use of wine. 
Yet even in the first case it may be required ; and in the 
second, its employment is imperative, when, as too often 
happens, excessive depletion has been resorted to." 

Absolute repose of body and mind in all cases is im- 
portant. 

When the effusion into the pericardium is abundant, a 
large blister should be applied over the prsecordia, [region 
of the heart,] or a succession of blisters may be necessary. 
The iodide of potassium has been advantageously adminis- 
tered to promote absorption. It has been proposed, as a 
forlorn hope in obstinate hydro-pericardium, to remove the 
fluid by the introduction of a trocar and canula. M. Aran, 
physician to the Hopital St. Antoine, Paris, relates a case 
of pericarditis with copious effusion in a young man aged 
23, which he treated by an injection of iodine. The peri- 
cardium was punctured from below upwards, with a capil- 
lary trocar, in the fifth intercostal space, a little below the 
spot where the dulness on percussion was well marked ; 
about 28 ounces of a transparent reddish serum were 
removed. A mixture, formed of four drachms of tincture 
of iodine, fifteen grains of iodide of potassium, and an 
ounce and a half of water, was then injected without causing 
any pain ; a drachm or two was allowed to escape before 
closing the wound. The fluid having reaccumulated, the 
operation was performed a second time with a stronger 
injection, formed of equal parts — twelve drachms — of tinc- 
ture of iodine and water, with one drachm of iodide of 
potassium. The treatment was successful. 



ENDOCARDITIS. 267 



ENDOCARDITIS. 

Endocarditis, or inflammation of the membrane which 
lines the interior of the heart and its valves, is of great 
interest, owing to the severe organic diseases which spring 
from it. 

Symptoms. — It chiefly gives rise to a sense of oppression 
and uneasiness at the precordial region; fever; small, 
feeble, and intermittent pulse ; great anxiety ; cold sweats ; 
oppressive dyspnoea ; jactitation ; and syncope. When the 
inflammation is only of limited extent, or when it assumes 
a chronic form, the symptoms are much milder and more 
obscure. 

Diagnosis. — If we apply the hand to the chest in simple 
endocarditis, the action of the heart will appear to be very 
violent ; sometimes a vibratory thrill will be felt. Percus- 
sion often discovers an augmented extent of dulness in the 
precordial region ; this dulness may be distinguished from 
that caused by pericardial effusion, by the beat of the heart 
appearing superficial instead of remote and distinct. If 
we listen to the heart's action we shall detect a bellows- 
murmur, the most constant and characteristic of the phe- 
nomena of endocarditis. The murmurs of purely acute 
endocarditis are thus arranged in order of frequency by Dr. 
Walsh e : Aortic obstructive ; mitral regurgitant ; aortic 
regurgitant; aortic obstructive and mitral regurgitant 
together ; aortic obstructive and regurgitant together. Pul- 
monary systolic and diastolic murmurs are infinitely rare. 
Dr. Walshe has never observed acute obstructive mitral 
murmur, nor acute regurgitant tricuspid murmur. 

For the further consideration of the physical signs, see the 
section on Diseases of the Valves of the Heart. 

Terminations. — The terminations of acute endocarditis 
are permanent valvular disease, followed by implication of 
the heart's substance, and all their combined consequences. 
Death rarely occurs from the acute disease. 

Treatment. — This must be the same as that recommended 
foi pericarditis. 



268 INFLAMMATION. 



CARDITIS. 

Carditis, or inflammation of the muscular substance of 
the heart, seldom occurs as a distinct affection ; being gene- 
rally combined with pericarditis or endocarditis, or with 
both. An instructive example has been recorded by Mr. 
Salter, in which the disease ran its course in seven weeks. 
It commenced with an acute pain in the left side of the 
chest, which came on when the patient was walking, lasted 
a short time, and recurred about a week afterwards, whilst 
he was using the same exercise; it subsequently became 
very frequent, and was induced by the slightest exertion. 
When Mr. Salter first saw him, about a week before his 
death, there was orthopnoea, and an uneasy sensation or 
dull pain referred to the stomach and middle of the sternum, 
[breast bone.] Venesection, calomel and opium, and counter- 
irritation, were the means adopted to stay the disease ; but 
they were unavailing, and death took place. At the post- 
mortem examination the pericardium was found inflamed, 
especially its diaphragmatic portion ; its vessels were dis- 
tended, and spots of ecchymosis [effusions of blood] were 
found beneath the serous membrane. The substance of the 
heart was moderately firm ; but the left ventricle had almost 
entirely lost the color of muscle, pus could be scraped from 
its surface, and in some parts there were small cavities in 
the muscular substance containing pus. 

VALVULAR DISEASES OF THE HEART. 

Causes, etc.— Most of the alterations in the internal lin- 
ing membrane of the heart result from inflammation, which 
gives rise to a deposit of lymph upon or beneath the serous 
membrane. The valves thus lose their thinness and trans- 
parency, become thick, puckered up, and adherent to each 
other or to the opposite walls of the channel. Independ- 
ently of inflammation, the valves may become covered with 
warty vegetations or excrescences, or they may be con- 
verted into bone. 

The effects are twofold : either to contract and narrc w 
the orifice, and so obstruct the passage of the blood — valvu- 



VALVULAR DISEASES OF THE HEART. 269 

lar obstruction; or by thickening and shortening the valves 
to make the orifice- more or less patent, [open,] and hence 
permit of regurgitation of blood — valvular insufficiency, re- 
gurgitant disease of valves, etc. There may be only valvular 
obstruction or valvular insufficiency in any given case ; but 
often these conditions coexist. 

Diagnosis. — In the diagnosis of these diseases, attention 
must be directed, firstly, to the physical signs ; and sec- 
ondly, to the chief physiological or functional symptoms. 

1. The Physical Signs. — The natural sounds of the heart 
are liable to be modified or changed by disease, causing 
either sound or both to be accompanied or to be supplanted 
by a noise which has been aptly compared to the blowing 
of a pair of bellows ; hence it is termed by us a bellows- 
murmur, and by the French a bruit de souffiet. A bellows- 
murmur may be harsh, or rough, or cooing, or whistling, or 
musical, but these modifications are of little importance; 
of whatever nature, it is caused either by the presence of 
obstructions which impede the free flow of blood through 
the heart and its great vessels — producing an organic mur- 
mur ; or by a supposed peculiar condition of the blood — 
giving rise to an inorganic murmur. When the valves of 
the heart are affected so that they act ineffectively, an 
organic bellows-murmur results. 

2. Physiological and Functional Symptoms. — The follow- 
ing are the chief: Difficulty of breathing, varying from 
the slightest dyspnoea to the most severe orthopnoea; 
much increased on ascending a height or making any 
exertion. Palpitation and irregular action of the heart, 
with the sounds and murmurs discoverable by auscultation, 
etc. Irregular pulse. In mitral disease, the pulse is gene- 
rally soft and irregular ; in aortic, hard, jerking, but regu- 
lar. Congestion of the lungs ; bronchitis ; pneumonia ; 
pulmonary hemorrhage, with or without pulmonary apo- 
plexy ; these symptoms being most urgent in mitral dis- 
ease. Hemorrhages from the nose, bronchial tubes, or 
mucous membrane of the stomach. Dropsy. Enlarge- 
ment of the liver and spleen, with disorder of the digestive 
organs generally. A peculiar appearance of the counte- 



270 INFLAMMATION. 

nance, wherein the face is puffed, the cheeks flushed and of 
a purple hue, the lips congested, and the eyes bright. 

As time advances, the heart disease generally becomes 
more aggravated : the patient becomes weak, and suffers 
immediately from over-exertion, mental emotion, improper 
food, or exposure to wet and cold ; and subsequently death 
ensues, either suddenly from syncope, or gradually from the 
progress of one or other of the secondary affections. The 
latter termination is the most common. 

Treatment. — In the treatment of the valvular diseases of 
the heart, three indications have generally to be followed : 

1st. To abate inordinate action of the heart by sedatives, 
as digitalis, hydrocyanic acid, and morphia. 2d. To ward 
off or gradually relieve the results of the cardiac disease, 
such as pulmonary congestion, pneumonia, hemorrhage, 
congestion of the liver and kidneys, dropsy, etc., by a nu- 
tritious diet, and by maintaining the various secreting organs 
in a healthy state ; and 3d. To endeavor to give strength 
and tone to the heart, so as to assist it to do its work, by 
nourishing food, a duly regulated supply of stimulants, 
breathing pure air, warm clothing, early hours, avoidance 
of all bodily and mental excitement, and by the administra- 
tion of tonics — especially the various preparations of steel. 

HEPATITIS, OR INFLAMMATION OF THE LIVER. 

Fever, tension, and pain of the right hypochondrium, 
often pungent, as in pleuritis, but sometimes dull, pain in 
the clavicle and top of the right shoulder, uneasy lying on 
the left side, difficult respiration, dry cough and vomiting, 
are the characteristics of hepatitis ; very frequently there is 
some degree of jaundice. 

Hepatitis has generally been considered of two kinds ; 
the one acute, the other chronic ; the former showing the 
essential character of genuine inflammation ; the latter ex- 
hibiting symptoms of less violence as to their inflammatory 
tendency, but an enlargement and hardness of the liver, 
with an obtuse pain. 

Besides the causes producing other inflammations, such 
as the application of cold, external injuries from contusions, 



INFLAMMATION OF THE LIVEE. 271 

blows, etc., this disease may be occasioned by violent exer- 
cise, by intense summer heats, by long-continued intermit- 
tent and remittent fevers, by high living, and an intemperate 
use of vinous and spirituous liquors, but more particularly 
the latter, and by various solid concretions in the substance 
of the liver. In most cases, the exciting cause of acute 
hepatitis will be found to be the partial application of cold 
or wet when the body is heated or over-fatigued by violent 
exercise. Derangement of the digestive organs, suppressed 
secretions, inflammations, compression, fevers, and mental 
solicitude, are very general causes of obstructions and dis- 
eases of the liver. 

In warm climates, this organ is more apt to be affected 
with inflammation than any other part of the body, proba- 
bly from the increased secretion of bile which takes place 
when the blood is thrown on the internal parts by an expos- 
ure to cold ; or from the bile becoming acrid, and thereby 
exciting an irritation in the part. An inflammation of the 
liver, and the diseases consequent thereon, are indeed affec- 
tions more frequently to be met with in warm climates than 
in cold ones. The liver, in warm climates, seems to be the 
seat of disease nearly in the same proportion that the lungs 
are in more northern latitudes. 

The acute species of hepatitis comes on with a sense of 
chilliness, followed by pain in the right hypochondrium, 
sometimes dull, sometimes sharp, extending up to the clavi- 
cle and shoulder of the right side, which is much increased 
by pressing upon the part, and is accompanied with a 
cough, oppression of breathing, and difficulty of lying, 
except on the side affected ; together with nausea and sick- 
ness, and often with a vomiting of bilious matter ; the in- 
testines are generally inactive, and the stools show a defi- 
ciency of biliary secretion, or at least of any intermixture 
of it with them ; the urine is of a deep saffron color, and 
small in quantity; there is loss of appetite, great thirst, 
and costiveness, with a strong, hard, and frequent pulse, of 
from ninety to one hundred in a minute, and sometimes in- 
termitting ; the skin is hot and dry at the same time, and 
the tongue covered with a white, and sometimes a yellowish 
18 



272 INFLAMMATION. 

fur ; and when the disease has continued for some days, the 
skin and eyes become tinged of a deep yellow, particularly 
when the inflammation is produced by calculi in the paren- 
chyma, or substance of the liver. 

In hepatitis, as well as in other diseases, we do not 
always find the symptoms of the same degree of violence 
as they are described in the definition : thus in some cases 
the fever is severe, in others it is scarcely perceptible ; in 
some instances the pain is very acute and violent; in 
others, collections of pus have been found after death, when 
no pain has been felt. When the pain is seated deep in the 
substance of the liver, as that possesses little sensibility, 
the pain is usually obtuse ; but when the surface is affected, 
it is acute, and apt to spread to the diaphragm and lungs, 
producing cough. 

Both ancient and modern nosologists have made a dis- 
tinction between the symptoms that occur when the inflam- 
mation occupies the convex or upper surface of the liver, 
and those that are present when the disease affects the con- 
cave or lower surface. It is said, when great difficulty of 
breathing, and cough, accompany the pain in the region of 
the liver, that these symptoms indicate the inflammation to 
be seated in the superior or convex part ; but where the 
inflammation occupies the concave or inferior surface, which 
lies contiguous to the stomach and duodenum, there is more 
sickness and vomiting ; and moreover, the pain is not so 
violent in the region of the organ as in the other instance. 

It seems probable, says Dr. Cullen, that acute hepatitis 
is always an affection of the external membrane of the 
liver, and that the parenchymatic is of the chronic kind. 

The chronic species is usually accompanied with a mor- 
bid complexion, loss of appetite and flesh, lowness of spirits 
and despondency of mind, headache or giddiness, general 
weakness, a morbid sensibility of the nervous system, cos- 
tiveness, indigestion, flatulency, acidity, and pains in the 
stomach, a yellow tinge of the skin and eyes, clay-colored 
stools, high-colored urine, depositing a red sediment and 
ropy mucus ; an obtuse pain in the region of the liver, ex- 
tending to the shoulder, together with a sense of weight, 



INFLAMMATION OF THE LIVER. 273 

unusual fulness, and some enlargement and hardness of the 
organ, and not unfrequently with a slight difficulty of 
breathing, or dyspnoea. In some cases of chronic inflam- 
mation of the liver, the pulse has been observed to in- 
termit. 

The symptoms are, however, often so mild and insignifi- 
cant as to pass almost unnoticed, as large abscesses have 
been found in the liver upon dissection ; which, in the per- 
son's lifetime, had created little or no inconvenience, but 
which we may presume had been occasioned by some pre- 
vious inflammation. 

We may readily distinguish hepatitis from pneumonia by 
the pain in the former extending into the shoulder ; by the 
sallowness of the countenance ; by the cough being unac- 
companied by expectoration ; and by the less degree of 
dyspnoea. The heat and pain not being increased upon 
taking any thing into the stomach, its being able to retain 
whatever liquids or medicines are received into it, without 
the immediate rejection of them, and the less prostration 
of strength, will distinguish it from gastritis. Hepatitis 
may be distinguished from spasm of the gall-ducts, by there 
being no nausea, by the pain being permanent, by the pulse 
being one hundred and upwards in a minute, and by the 
patient always preferring to keep the body in a straight 
quiescent posture ; whereas, the greatest ease, when there 
is spasm of the gall-ducts, is obtained by bending the body 
forward on the knees. 

Hepatitis, like other inflammations, may end in resolu- 
tion, suppuration, gangrene, or scirrhus, in which the liver 
becomes swelled and hard ; but its termination in gangrene 
is a rare occurrence. It is frequently accompanied with 
chronic obstruction. Its tendency to run into suppuration 
is not so great in this country as in warm climates. Indeed, 
it is rather a rare occurrence here. The period of suppura- 
tion is influenced by the degree of inflammation, the season 
of the year, climate, and the remedies that have been em- 
ployed. Scirrhus may exist in the liver without previous 
active inflammation. 

The disease is seldom attended with immediate fatal con- 



274 INFLAMMATION. 

sequences, and is sometimes carried off by a hemorrhage 
from the nose or hemorrhoidal vessels ; and likewise by 
sweating, by a diarrhoea, or by an evacuation of urine, 
depositing a copious sediment. In a few instances it has 
been observed to cease on the appearance of erysipelas in 
some external part. Serous effusion in the cavity of the 
abdomen is sometimes a consequence of hepatitis showing 
itself under the form of ascites, or dropsy of the belly. 

The most favorable signs in hepatitis are, a gradual 
abatement of the fever, an improvement in the complexion, 
the return of the appetite, and an increase in the bulk of 
the body. Intensity of pain in the region of the liver, a 
full and frequent pulse, considerable heat, thirst, dry skin, 
costiveness, and frequent rigors, denote approaching suppu- 
ration. 

When the inflammation terminates in the formation of 
matter, the inflammatory symptoms gradually subside and 
give way to those of suppuration. The fever becomes 
somewhat intermittent, frequent rigors or shiverings are 
felt, the sense of weight in the part increases, the pains 
are less acute but throbbing, the tongue is white, with 
flushings of the countenance ; and when the abscess is 
formed near the edge of the liver, or towards the concave 
surface, it not unfrequently projects under the false ribs, so 
that the fluctuation may be felt externally. If the abscess 
forms on its convex surface, it points towards the lungs, 
corrodes through the diaphragm, and distends the pleura, 
which it sometimes pushes through the spaces between the 
ribs. At last the matter finds its way through the inter- 
costal muscles, and may be distinguished through the skin. 
If the abscess is apparent, there will be found a fluctuation 
in the centre, while the circumference remains hard. A 
change of color in the skin only occurs where a great quan- 
tity of matter is accumulated ; or where, by its bad quality, 
it changes the color of the teguments. If much pressure 
on the tumor with the fingers is employed, a pulsation may 
often be felt, particularly in irritable habits. Sometimes 
the inferior lobe of the lungs contracts adhesions with 
those points of the diaphragm connected with the abscess, 



INFLAMMATION OF THE LIVER. 275 

by which means the matter will "be discharged by the bron- 
chise spit up ; this is, however, a rare occurrence ; but it 
often happens that the matter is effused into the cavity of 
the chest, and forms a purulent empyema. It likewise 
happens now and then that the sides of the abscess, form- 
ing adhesions with the stomach, or much oftener with the 
colon or large bowel, the matter is discharged into their 
cavity, and evacuated either by vomiting or stool. 

On dissection of those who die of hepatitis, the liver is 
often found much enlarged and hard to the touch, its color 
is more of a deep purple than what is natural, and its mem- 
branes are more or less affected by inflammation. Dissec- 
tions, likewise, show that adhesions to the neighboring parts 
often take place ; that tubercles, as well as vesicular cysts, 
denominated hydatids, are sometimes found in it; and that 
large abscesses, containing a considerable quantity of pus, 
are often formed in its substance. Biliary calculi are now 
and then met with. • In a few instances, the livers of those 
who have died of this disease have been found in a putrid 
state, resembling a honeycomb ; but the most common ap- 
pearance to be observed in those who die of diseased 
liver, is the formation of tubercles in its substance. The 
liver has not unfrequently been found after death to be 
indurated or otherwise injured, without any marked indica- 
tion of disease during the life of the patient, except dys- 
pepsia or simple indigestion. 

Treatment. — What constitutes great difficulty in manag- 
ing hepatitis is, that in many cases the symptoms which are 
primary and indicative of inflammatory affection, are but 
very slightly marked. The pain in the side is often not 
constant or acute, the patient himself takes little notice of 
it, seldom mentions it unless he is asked about it, and when 
questioned concerning it, he only tells you, perhaps, that 
he has felt at times slight pains about the pit of the stomach, 
or in the right side. It is only by observing the secondary 
symptoms, such as a diarrhoea, or a short dry cough, and 
pain felt at the top of the shoulder, or that there is a de- 
gree of fulness or tenderness on pressing on the organ, with 
some yellowness of the eyes and countenance, that the true 



276 INFLAMMATION. 

state and nature of the disorder is to be ascertained in 
such cases. 

Perhaps this disease has generally been worse managed 
than any of the other inflammatory diseases. It will not 
usually bear depletion and the antiphlogistic regimen as 
well. The reason may be found in the nature of most of 
the remote causes of the disease, and in the peculiar circum- 
stances connected with the circulation of the organ, and also 
in its grade of vital activity, and the kind of office it per- 
forms in the animal economy. ' The remote or predisposing 
causes of hepatitis are mostly of a debilitating or depress- 
ing character, having a tendency to bring about a low state 
of vitality, so that debilitants, or depletives, cannot be 
appropriate remedies ; the peculiar circulation in the liver 
also forbids their use, which I will very briefly describe, 
so that the reader may perceive the force of this reason for 
avoiding depletion : The blood, after having circulated 
through the stomach, bowels, and other contents of the 
abdomen and pelvis, is collected into one large vein called 
vena portarum, or vein of the liver, and enters this organ, 
and is distributed through its substance in the manner of 
an artery. What are the objects of this arrangement we 
cannot now stop to consider, but it is from this venous 
blood that the bile is secreted, and it is supposed that the 
blood undergoes other changes in the liver besides that 
which results from having the gross materials of which bile 
is composed separated from it ; but whatever are its uses, 
it is certain that this arrangement causes a very slow and 
weak movement of the blood, and renders the organ easily 
influenced by depressing causes ; the vital manifestations 
of the liver are also of a very low order, as might be ex- 
pected from the presence of so much venous blood, and 
hence reaction against the influence of depressing agents is 
also feeble ; all of which will naturally heighten the perni- 
cious effects of any measure w T hich has a tendency to 
weaken or lower the energies of the system. It is true, 
the liver receives some arterial blood through the hepatic 
arteries ; but these appear ridiculously small in proportion 
to the great size of the organ, and can evidently merely 



INFLAMMATION OF THE LIVER. 277 

serve to supply its substance with the materials of nutrition 
sufficient to keep up a low order of organization ; and we 
accordingly find that its sensibility and irritability are very 
deficient. Arterial circulation is much better in the invest- 
ing membrane of the liver than in the gland itself; it is 
also better supplied with nerves of sensation; hence, 
inflammation, seated in it, is of a more active character, and 
occasions much acute suffering — it complains very much 
as the pleura does when it is inflamed. 

We see, therefore, that inflammation of the liver must be 
treated with reference to all those circumstances which 
render the reactive powers of the liver very feeble : such 
means as will arouse the capillaries and excite absorption 
of morbid deposits, without inducing further debility, can 
alone be used with advantage. The best internal means 
for accomplishing these results I have found to be the fever 
syrup, given in full doses, viz. : a tablespoonful every two 
hours, or the following pill : sul. quinine thirty grains, 
blue-mass twenty grains, piperin ten grains, oil of sassafras 
ten drops. Make fifteen pills, and give one every two 
hours ; or the pills and the syrup may be given alternately, 
making the dose of each four hours apart. Once every day 
the bowels must be moved, and if the above means fail to 
produce at least one or two free evacuations, a tablespoon- 
ful of castor oil, or epsom salts, must be given, and aided, 
if necessary, in the course of three hours, with injections 
of soapsuds. 

The best local remedies are : first, the chloroform lini- 
ment, or a poultice of mush, or cloths wrung out of hot 
mustard water, or simply hot water sprinkled with the 
liniment. These external means must not be looked upon 
as something that may be done if convenient, or left undone 
if not convenient ; they are a very important part of the 
treatment, both in this and other inflammatory diseases in 
which they have been or will be prescribed ; and I wish it 
understood that my plan of treatment cannot be justly 
blamed for want of success if the external remedies are 
neglected. But if the patient is not materially relieved by 
these means in twenty-four hours, secondly, a blister — 



278 INFLAMMATION. 

a good fly-blister — large enough to cover all the parts which 
are tender, or a little larger, must be applied; and hot 
cloths applied over it, as I directed in another place, for the 
purpose of hastening its drawing and increasing its effects. 

I once had a case of acute inflammation of the liver 
which came very near ending in suppuration ; and I will 
here notice it, in order to illustrate what can be done by 
perseverance under difficulties. After having used other 
means, I thought it necessary to apply a blister, and did so ; 
but the insensibility of the skin, directly over the disease, 
was so great, that no effect was made, except around the 
margin. I cut the blister a little smaller, and reapplied it ; 
over which I had placed a poultice made with vinegar 
instead of water ; in six hours it was again examined, and 
found to have drawn over all the space except a centre of 
about the dimensions of a small saucer, over the centre of 
the diseased part. Knowing that any delay would now 
defeat my purpose of causing absorption and making the 
inflammation terminate by resolution — in fact, the probabili- 
ties were that suppuration had already commenced — I at 
once resolved on a bolder course ; and prepared a fold of 
cloth, large enough to cover the part that wouldn't blister, 
and covering all the other space with a tallowed rag, to 
prevent it from being acted on, saturated the first with 
strong nitric acid, [aquafortis,] and let it remain half an 
hour. On removing it I found the surface black and 
spongy, and then ordered the other dressings removed, and 
the whole implicated surface enveloped in a well-greased 
mush poultice. This succeeded. I had, the next day, the 
satisfaction of seeing all the surface covered with healthy 
matter or pus, which informed me that inflammatory action 
in deeper-seated parts had yielded, and that an abscess was 
prevented, and the danger of losing by death a very 
interesting young lady was now pretty well over. No 
further treatment was necessary in this case but to keep 
the bowels open with salts and cream of tartar, and to 
attend to the blister.. I will here notify my readers, that 
when they have succeeded in blistering the surface over an 
internal inflammation after much difficulty, they may ex- 



INFLAMMATION OF THE LIVER. 279 

pect trouble with the blister itself; for the mischief seems 
to be transferred from within to the blistered surface, and 
often causes a degree of irritation which will fully test the 
patience and powers of endurance of the patient, and ex- 
haust the skill of the physician or nurse. Full doses of 
opiates must be given, and the blister dressed thus : add 
four grains of morphine, or half an ounce of laudanum, to 
six ounces of mucilage, and a fine soft cloth — that which 
has been w^ell worn is always best — saturated in this 
mixture and neatly applied to all the vesicated surface. 
This is to remain ; now keep this wet by placing several 
folds of old cotton or linen cloth, which has been saturated 
with the emulsion, over it, and renew it often enough to 
prevent the first from becoming dry. If the heat and 
irritation be great after applying the first cloth as directed, 
you may pour a stream of tepid water on it, and continue 
the pouring until the patient ceases to complain ; then pro- 
ceed with the saturated cloths as before directed. I wish 
these directions remembered, as they apply to all irritable 
blisters, and will not be again repeated. 

The above measures, if fully carried out, will, I think, 
always prevent inflammation from running into suppuration, 
or becoming chronic ; but if they should be neglected, or fail 
to fully succeed, or if the case has first presented itself in 
the chronic form, then we must introduce some new reme- 
dies. In chronic inflammation of the liver the bowels are 
usually very torpid ; this is partly owing to the bile, which 
is the natural purgative, not being secreted, or not being of 
the right kind ; the principal objects, therefore, which we 
must have in view in the management of this disease are, 
to regulate the action of the bowels, and to restore or 
correct the secretion of the bile. The fever syrup, given 
in tablespoonful doses every four or six hours, and the 
following pill, taken between each dose, will answer both 
of these purposes : calomel, comp. ext. of colocynth, and 
castile soap, each 30 grains; make 18 pills. 

Rigid attention must be paid to the diet during the cure 
of this disease ; that is, nothing gross must be taken, nor 
any thing which the patient cannot readily digest. Sponging 



280 INFLAMMATION. 

the body once every day with cold water, and then having 
the surface rubbed with a coarse towel until the skin becomes 
red, will be found very beneficial, both in this and every 
other case, during convalescence from inflammatory or 
febrile diseases. 

As soon as the patient can bear it, he should take exercise 
on horseback ; don't ride out just for the sake of the ride, 
but devise some excuse, either of business or pleasure, so 
that the mind may be broken off from an everlasting 
brooding over the disease, and watching for every little 
pain or peculiar feeling, which often are really the result of 
this morbid anxiety acting through the nerves. 

INFLAMMATION OF THE STOMACH GASTKITIS. 

Inflammation may be confined to the mucous membrane 
which lines the stomach, or it may involve all the structures 
which enter into the composition of this organ ; and names 
have been given to the disease indicating the particular 
tissue principally affected ; but as it is difficult to distin- 
guish these varieties, and especially as it leads to no 
practical advantage — all being subject to the same treat- 
ments — we will not complicate the subject by drawing use- 
less distinctions, but consider all as one disease. 

Gastritis, like other inflammations, may be either acute 
or chronic ; we will first consider 

ACUTE GASTRITIS. 

This is by no means common as an independent affection, 
though very frequently found associated with other diseases, 
of which it may be either an effect or a mere attendant, 
having its origin in the same cause. Few organs resist so 
firmly the ordinary direct causes of inflammation as the 
stomach, and few are so readily affected through the sym- 
pathies. The object of this provision is evident. An organ 
so important in its functions, and so much exposed to irri- 
tant influence from without, would be constantly suffering, 
and causing the system to suffer, if readily excited into 
inflammation by an excess of such influence ; while, if 
undisturbed by inflammation, or morbid excitement in 



INFLAMMATION OF THE STOMACH. 281 

other organs, it would continue to furnish, through the 
function of digestion, materials to the blood calculated to 
sustain the disease. 

Symptoms. — -In severe cases of acute gastritis there is 
usually a burning pain in the epigastrium, or pit of the 
stomach, with incessant nausea and vomiting, commencing 
with the attack, and continuing, with greater or less 
intensity, till near the close. The pain is increased by 
pressure from without, and by a deep inspiration, and is 
sometimes excruciating in the act of vomiting. The sub- 
stances thrown up from the stomach are at first the food or 
chyme, and afterwards bile or mucus, and whatever may be 
swallowed, and are sometimes more or less deeply tinged 
with blood. There is occasionally considerable difficulty of 
deglutition, in consequence of spasm of the oesophagus or 
cardiac orifice. The thirst is intense, and the patient is 
constantly calling for cold water, although, if taken freely, 
it produces uneasiness and oppression by the distension of 
the stomach, and is often immediately rejected. The tongue 
is at first usually covered in the middle and posterior part 
with a whitish fur, while its tip and edges are red, and red 
papillae are visible through the coating; but sometimes it 
is red, smooth, dryish, and without fur, from the commence- 
ment. The bowels are almost always constipated, unless 
they participate in the inflammation, in which case they are 
looser than in health. The patient lies on his back, is apt 
to be low-spirited, is restless and unable to sleep, and has a 
feeling of great debility, with an expression of countenance 
indicating anxiety and distress. The pulse is frequent and 
sometimes full, but usually small and corded ; the respira- 
tion often short and hurried; the skin hot and dry; and 
the urine high-colored. 

Should the disease now take a favorable turn, the pain 
and vomiting abate ; the tongue becomes paler and moister, 
the pulse slower, fuller, and less corded, the skin cooler and 
softer; and sometimes a general moisture of the skin, or 
relaxation of the bowels, evinces that the crisis is passed. 
But should it advance unfavorably, the tongue, if before 
coated, becomes smooth, red, and dry, and towards the close 



282 INFLAMMATION. 

is occasionally covered, as well as the inside of the cheek, 
with a thrush-like exudation; the skin becomes cool and 
pale, and the pulse more frequent, feeble, and thread-like ; 
the body emaciates rapidly; debility and restlessness in- 
crease ; delirium frequently occurs ; hiccough harasses the 
patient ; active vomiting is succeeded by mere regurgita- 
tion ; instead of mucus or bile, a black matter like coffee- 
grounds is sometimes ejected; the tenderness on pressure 
diminishes, and pain sometimes ceases entirely; the counte- 
nance sinks, and assumes a haggard aspect; and death 
occurs, preceded by cold extremities, a scarcely perceptible 
pulse, and other evidences of extreme exhaustion. The 
complete suspension of pain, without amelioration in other 
respects, is an unfavorable sign. In some rare instances, in 
the latter stage, the pain suddenly increases and becomes 
more diffused, and extreme tenderness upon pressure is felt 
over the whole abdomen, which swells from an accumula- 
tion of gas. 

In milder forms of the disease, the symptoms above 
enumerated as characterizing the earlier stages, are expe- 
rienced in a less degree. Sometimes, instead of severe 
pain, there is merely a feeling of oppression, weight, or 
constriction; instead of obstinate and incessant vomiting, 
merely a slight nausea, or a disposition to vomit whatever 
is taken. The pulse, too, in such cases, is usually more 
full and developed. Epigastric tenderness is very seldom 
absent. " Occasionally, even in severe gastritis, there is a 
want of all the characteristic symptoms ; so that the first 
evidence of the nature of the complaint is that afforded by 
dissection. This is sometimes attributable to the fact that 
various secondary or sympathetic affections, such as severe 
headache or delirium, pains in the back, or limbs, or irrita- 
tion of some portion of the pulmonary apparatus, become 
so prominent as to act revulsively in relation to the gastric 
sensibilities, and thus to mask the real disease. When 
gastritis attends other diseases, it is peculiarly liable to be 
thus concealed, as in that form of the derangement of 
drunkards which immediately follows an occasional debauch, 
and in which it is highly important that it should be 



INFLAMMATION OF THE STOMACH. 283 

recognized." — Stokes. The duration of acute gastritis is 
very variable. In violent cases, as from corrosive poison, 
death in some instances takes place in less than twenty- 
four hours ; while in others, the disease continues from two 
to six weeks, and then, if not fatal, ends in a slow conva- 
lescence, or subsides into chronic gastritis of indefinite 
duration. Milder cases of the disease often yield speedily 
to appropriate treatment; but, if not taken in time, may 
run on for weeks, and at last assume the chronic form. 

Causes. — Acute gastritis is rarely produced by those 
vicissitudes of temperature which are so often the cause 
of other inflammations. It most frequently results from 
caustic or irritant substances taken into the stomach. The 
corrosive mineral and acrid vegetable poisons often prove 
fatal in this way. Milder stimulants, such us alcoholic 
drinks, the stronger condiments, and even an excess of 
food, sometimes produce acute inflammation of the stomach, 
but rarely unless in cases where a strong predisposition ex- 
ists. Large draughts of very cold water after fatiguing 
and exhausting exertion, when the body is heated and per- 
spiring, are among the causes. Very severe, cases some- 
times result from the translation of acute gout or rheuma- 
tism. Andral relates a striking case of this kind, in which 
a predisposition to disease of the stomach appeared to be 
occasioned by distress of mind. But the state of convales- 
cence from certain acute diseases, especially cholera, and 
the previous existence of chronic inflammation of the 
stomach, constitute the strongest predisposition. It is in 
these conditions that excess in eating and drinking most 
frequently brings on an attack of acute gastritis. 

But this disease occurs much more frequently as an 
attendant upon other diseases than as an original or inde- 
pendent affection. It is peculiarly apt to occur in the 
course of fevers, particularly in bilious remittent and yel- 
low fevers, and not unfrequently also attends the eruptive 
and inflammatory fevers. In some instances, it is very 
difficult, nay, impossible to decide whether the gastritis be 
the original or a secondary affection. The decision, how- 
ever, is of the less consequence; as, in either case, a promi- 



284 INFLAMMATION. 

nent indication would be to combat the disease of the 
stomach; as this is at least one of the chief sources of 
danger. 

General Treatment. — Should, the gastritis have been 
caused by a corrosive or acrid poison, and the stomach not 
yet fully evacuated, the first object in the treatment should 
be to remove the offending matter, either by means of copi- 
ous draughts of warm water, or other bland liquid, or, if 
these should be insufficient, by means of a gentle emetic of 
ipecacuanha accompanied with free dilution. At the same 
time, substances should be administered calculated to act as 
antidotes by neutralizing the poison ; and, after the stomach 
has been thoroughly cleansed, castor oil $r epsom salts 
should be given along with the antidote, in order to evacu- 
ate any portion of the poison which may have passed into 
the bowels. The inflammation is then to be treated as if it 
had arisen from other causes, attention being always paid 
to whatever peculiar condition of the system may have 
arisen from peculiar properties in the poison, and to the 
fact that, if great organic injury has been inflicted, the 
powers of the system are too much prostrated to admit of 
the employment of debilitating remedies. 

In the early stage of gastritis, if the patient has not 
been previously debilitated, and the system is not under 
the influence of some powerfully depressing agent, as in 
typhus fever, and the case of certain poisons, blood should 
be taken freely from the arm ; and, if the pulse and gene- 
ral strength do not fail under the loss, the bleeding should 
be repeated once and again, until a decided impression is 
made on the disease. The pulse and muscular strength of 
the patient are not to be taken as exclusive guides in acute 
gastritis. They both feel the depressing influence of the 
attending nausea, and will often rise under depletion, in 
consequence of the diminished force of the disease in which 
the nausea originates Besides, a certain energy of stom- 
ach seems necessary to support the actions of the circula- 
tory system; and when the functions of that organ are 
wholly suppressed by excessive inflammation, the heart, 
though irritated, contracts with comparatively little force. 



INFLAMMATION OF THE STOMACH. 285 

Diminish the inflammation, and the heart resumes its 
power. Venesection is safe, so long as the pulse, as it not 
unfrequently does, rises and becomes more developed under 
the lancet. 

As constipation is an almost uniform attendant on un- 
complicated gastritis, cathartics would appear to be indi- 
cated ; but medicines of any kind taken internally are apt 
to be rejected, or to aggravate the inflammation ; and most 
authors recommend either their very sparing employment, 
or a total abstinence from them. Nevertheless, from five 
to fifteen grains of calomel may often be usefully given, in 
the earlier stage, after the due loss of blood. This cathar- 
tic is but slightly if at all irritant to the inflamed mem- 
brane, and is sometimes retained with the effect of calming 
the stomach, when other substances, even small quantities 
of cold water, are rejected. Besides, it operates favorably 
by unloading the portal veins through the secretion of bile, 
and thereby diminishing congestion in the stomach. The 
bowels should afterwards be kept open by the frequent use 
of injections. In some cases, when medicines are tolerated, 
a little castor oil or carbonate of magnesia, or other mild 
cathartic, may be administered with advantage ; but, if 
found to disturb the stomach, they should not be persevered 
in. The effervescing draught will often operate favorably, 
by promoting perspiration and reducing fever ; but this also 
will sometimes prove irritant, and must be relinquished. 
Opium, or one of the salts of morphia, may be given when 
the first violence of the inflammation has subsided. A full 
dose may be administered at bedtime, and repeated in an 
hour or two if it should not procure rest. Calomel, in 
minute doses, may often be usefully combined with the 
opium. Half a grain or a grain of opium, with a like quan- 
tity of calomel, in the form of pill, repeated every four 
hours, will generally be sufficient for the purpose. When 
the vomiting is obstinate, and easily excited, so that even 
these medicines cannot be retained, advantage will accrue 
from injections of laudanum with a solution of starch or 
flaxseed tea. Throughout the complaint, mustard baths, or 



286 INFLAMMATION. 

other measures for exciting action in the lower extremities, 
should be employed when these are pale and cold. 

The patient should not be allowed to drink largely ; but 
he will derive relief from occasionally swallowing a mouth- 
ful of very cold water, or from keeping ice in his mouth, 
and swallowing it as it dissolves. Few measures will be 
found more grateful than this, while it proves positively 
useful in the relief of the inflammation. Stokes recom- 
mends that small pieces of the ice should be swallowed 
undissolved, after they have remained in the mouth a short 
time, so as to round off the angles. Iced lemonade may 
sometimes be favorably substituted for pure water. In the 
early stages, no other nutriment should be allowed than a 
solution of gum-arabic, weak barley-water, or some other 
mucilaginous or farinaceous drink ; and even these may be 
dispensed with at first ; but in the more advanced stages, 
when the debility is great, and an absolute necessity exists 
for the support afforded by nourishment, fresh milk mixed 
with lime-water will be found both grateful and useful. 
These should be given in small quantities, frequently re- 
peated, as from half an ounce to' an ounce of each every 
hour. In a still more advanced stage, chicken-broth, plain 
cream, or ice-cream may be carefully administered. In con- 
valescence, the utmost caution should be observed to guard 
the patient against imprudence in eating, as nothing would 
be more likely to occasion a relapse. 

Local Treatment. — No one remedy in the treatment of 
acute gastritis is more important than leeches to the pit of 
the stomach. The most decided relief is often experienced 
from this remedy, in some instances even while the leeches 
are drawing. The principle upon which leeching operates 
with so much advantage is not obvious. Some refer it to 
revulsion, and the direction of the current of blood from the 
stomach to the surface. But in this way the leeches should 
prove equally useful applied to the sides or back, as these 
parts are nearer even than the epigastrium to the source 
whence the stomach receives its supply of blood. May 
not the result be ascribed to some undefined sympathy be- 



CHRONIC INFLAMMATION OF THE STOMACH. 287 

fcween the epigastrium and the gastric mucous membrane ? 
In the intervals between the leechings, warm fomentations 
or light emollient poultices should be applied over the 
region of the stomach, unless found very oppressive by 
their weight. Care, however, must be taken that they do 
not produce too copious a flow of blood from the leech-bites. 
Cold applications, and even ice, have been recommended as 
preferable to warm fomentations ; chloroform liniment may 
also be used with much advantage, and I have frequently 
seen the cold cloth, or "half-pack," have the most happy 
effect. In the advanced stages, decided benefit will some- 
times accrue from blistering ; and advantage may be taken 
of the raw surface thus obtained, to relieve nausea and 
vomiting, by sprinkling on the raw surface a grain or two 
of the acetate or sulphate of morphia. 

It is scarcely necessary to state, that the above plan of 
treatment may be applied, in various degrees and with 
various modifications, according to the nature of the case, 
as well to the inflammation of the stomach which attends 
other diseases, as to idiopathic gastritis. 

CHRONIC GASTRITIS. 

There is no distinct line of division between this and the 
former variety of gastritis. The extremes could not be 
confounded ; but of the numerous intermediate grades, it 
would often be difficult to decide which might belong to the 
one, and which to the other variety. If the attendant, how- 
ever, observe the same gradation in the treatment which 
he finds in the character of the disease, no harm can result. 

Symptoms. — When not the result of the acute form, 
chronic gastritis in general approaches so gradually, that it 
seldom attracts the serious attention of the patient, until it 
has existed a considerable time. The first symptoms are 
usually some uneasiness in the region of the stomach after 
eating, more or less derangement of the appetite, and a 
feeling of general discomfort during digestion, with occa- 
sional headache, and vague pains or soreness in the limbs 
as if from fatigue. Sometimes nausea and vomiting occur 
at the commencement. The symptoms gradually increase 
19 



288 INFLAMMATION. 

in intensity and diversity ; and the disease puts on a greai 
variety of aspects, dependent on the degree, extent, stage, 
cause, and character of the inflammation, the tissue or part 
affected, the constitution and habits of the patient, and the 
almost infinite diversity of sympathetic derangements. In 
almost all cases, perhaps in all, there is more or less uneasi- 
ness about the pit of the stomach or epigastrium. This 
generally amounts to pain, which, however, is exceedingly 
variable, being sometimes acute, lancinating, or spasmodic, 
sometimes slight, dull, and little more than soreness. Fre- 
quently there is a sense of heat or burning, which some- 
times extends up the oesophagus, or over the chest, particu- 
larly on the left side, and is hence called heart-burn. Instead 
of pain, there is often a feeling of fulness and distension, 
or of weight or constriction, or of gnawing at the epigas- 
trium, which is for the most part also, though not invaria- 
bly, sore when pressed. The uneasiness is sometimes 
general over the epigastric region, or even extends under 
the ribs on both sides, and under the sternum or breast- 
bone ; but in other cases it is shifting, or confined to one 
spot ; and this occasionally answers to the particular part 
of the stomach affected. Frequently, also, pain is felt in 
other places, as in various parts of the chest, in the shoulder 
and arm, and in the back immediately behind the region of 
the stomach. The sensation is seldom constant ; but has 
exacerbations and remissions, or entirely intermits, and is 
generally worse immediately after eating, or during diges- 
tion. It sometimes commences at a certain period after a 
meal. 

The appetite is variable in different cases, and sometimes 
in the same case. Occasionally it is little affected ; and, 
in such cases, there is reason to think that the inflammation 
is very moderate, or confined to a comparatively small 
portion of the stomach. Very generally, however, it is 
deranged, for the most part diminished, sometimes nearly 
or quite lost, and occasionally craving. In the last case, 
though the patient may begin to take food eagerly, yet the 
disposition is apt to pass away after a small portion has 
been swallowed, and is even followed by a feeling of dis- 



CHRONIC INFLAMMATION OF THE STOMACH. 289 

gust. Instead of a genuine appetite, there is often a sensa- 
tion as of hollowness or sinking at the stomach, with a 
feeling of faintness, which leads to the desire for food, and 
is sometimes relieved by it. The same want of the system 
is, in some instances, expressed by a headache or dry cough, 
which ceases after a meal. The patient sometimes dreads 
food, from the remembrance of the uneasiness it has occa- 
sioned. The taste is often vitiated, and substances leave 
an impression of sourness in the mouth after being swal- 
lowed. There is usually thirst, and a desire for cold drinks, 
which, if moderately taken, afford relief; while hot and 
stimulating drinks increase the uneasiness. Sometimes, 
however, the thirst is not greater than in health. 

Large quantities of gas are sometimes evolved in the 
stomach, which occasion frequent belching. The gas is in 
some instances inodorous, in others fetid and irritating. 
Eructations of sour and acrid liquids are not uncommon. 
Vomiting is also a frequent attendant. It occurs seldom at 
the commencement of the attack, but is apt to become more 
frequent, and, at length, in some cases, attains such a 
degree, that not a meal, and scarcely a mouthful of food, 
can be swallowed without being discharged. It is wonder- 
ful how long patients sometimes live, and even retain their 
flesh, who vomit apparently all their food. Portions, how- 
ever, must remain and be digested. The matters vomited 
are food, bile, mucus, sour and acrid liquids, which seem to 
excoriate the throat in their passage, and, in some instances, 
blood mixed or unmixed, fresh or altered by the action of 
the gastric juice. Sometimes, especially in the latter stages, 
and when ulceration exists, a dark matter resembling coffee- 
grounds is discharged from the stomach, and is also found 
in the evacuations from the bowels. This is blood some- 
what modified by an imperfect secretory effort of the 
vessels. The discharge of these various substances often 
affords so much relief to the patient, that he acquires the 
very injurious habit of throwing them up voluntarily. In 
some cases, large quantities of a glairy fluid like the unco- 
agulated white of eggs, or of the ordinary mucus of the 
stomach ; or of a tasteless colorless liquid like saliva, are 



290 INFLAMMATION. 

discharged, often rather by a species of eructation than by 
vomiting. 

Constipation almost invariably exists, unless in cases in 
which the inflammation extends to the bowels. 

The tongue is, in some rare cases, little if at all affected ; 
but generally it is either coated more or less with a whitish 
or yellowish fur, with the reddened papillae projecting, or is 
red and smooth, or has the papillae enlarged and reddened 
without other change. It is seldom so dry as in acute gas- 
tritis, but is often clammy or dryish, especially in the 
morning, or after sleep. In the advanced stages, it is 
occasionally covered with aphthae, or a thrush-like exu- 
dation. This is supposed to indicate ulceration of the 
stomach, and is usually an unfavorable, though by no means 
necessarily a fatal sign. 

The pulse is sometimes scarcely more frequent than in 
health, and may even be less so. Occasionally it is irregu- 
lar and intermittent. Usually, however, it is somewhat 
increased in frequency and tension. In some instances, 
there is a slight febrile paroxysm after eating ; and in the 
advanced stages, the pulse often becomes very frequent; 
and even hectic fever may set in. Except in this latter 
state, the skin is almost invariably dry, and sometimes even 
harsh, with a disposition to eruptive affections of various 
kinds, especially urticaria, [nettle-rash.] The soles of the 
feet, and the palms of the hands, are in some persons dis- 
tressingly hot; while in others there is a disposition to 
coldness of the extremities. 

The secretions are almost always more or less deranged. 
The saliva is not unfrequently sour, the bile scanty, super- 
abundant, or deranged, and the urine variously disordered. 

The nutritive process is differently affected in different 
cases. Sometimes the patient appears not to lose flesh for 
a considerable time after the commencement of the disease, 
and, in a few instances, retains his fulness till near the close. 
But usually there is great emaciation. 

The sympathetic disorders of the nervous system are 
almost infinitely numerous and diversified. Among the 
more common may be enumerated headache, giddiness, per- 



CHRONIC INFLAMMATION OF THE STOMACH. 291 

verted vision, buzzing or roaring in the ears, dyspnoea, a 
dry hard cough, palpitations, violent pulsations in the epi- 
gastrium, a general feeling of uneasiness, vague pains in the 
extremities, and great mental anxiety or dejection, with 
perverted feelings, and notions amounting sometimes to 
hypochondriasis. 

The duration of the disease is usually considerable, not 
unfrequently for years. It seldom marches steadily forward, 
but is liable to frequent changes ; the patient sometimes 
approaching to recovery and then relapsing, and going 
through this alternation several times before recovery or 
death. Under favorable circumstances of position, consti- 
tution, and treatment, the disease very generally terminates 
favorably, unless complicated ; and the patient sometimes 
recovers from the most alarming symptoms. Even large 
ulcers heal. But death is not an unfrequent result. It is 
usually preceded by great emaciation and debility, some- 
times by hectic fever ; and the patient often sinks under a 
complication of disorders, originating in sympathy with the 
stomach, but constituting ultimately the chief source of 
danger. The fatal result is sometimes immediately pro- 
duced by an attack of peritonitis, consequent upon the 
escape of the contents of the stomach, through an ulcerated 
opening, into the cavity of the abdomen. The ulcer having 
destroyed nearly the whole thickness of the coats, the 
remaining slender portion is ruptured by some mechanical 
violence, as by over-distension of the stomach, the act of 
vomiting, or by voluntary straining. The penetration, how- 
ever, of the coats of the stomach is not necessarily fatal. 
The diseased surface contracts adhesions with that of some 
adjacent viscus, the body of which thus forms a floor for the 
ulcer. The liver, spleen, or pancreas may serve this useful 
purpose. Sometimes the stomach and colon become united, 
and communicate so that the contents of the former escape 
through the latter. These results, however, are more com- 
mon in cancer of the stomach than in ulceration of the 
ordinary character. 

It has been mentioned, that numerous varieties of chronic 
gastritis exist. Sometimes the symptoms are comparatively 



292 INFLAMMATION. 

mild from the commencement, and continue so through its 
whole course. In other cases, though mild in the beginning, 
and for a variable length of time afterwards, they gradually 
increase, until the case assumes a serious aspect. In others, 
again, they exhibit an alarming intensity almost from the 
outset. In a few instances, the complaint runs on in its 
mildest form for a long time, and then suddenly breaks out 
into fatal violence. Under such circumstances, there is 
reason to suppose that the inflammation may have been 
confined to a small portion of the stomach, but, ending in 
ulceration, exhibits at length evidences of great organic 
mischief. This condition may be suspected when vomiting 
of blood, or of matter like coffee-grounds, supervenes upon 
the ordinary symptoms of chronic gastritis. The inference, 
however, is by no means positive, as both these results 
may occur without any solution of continuity in the mucous 
membrane. Perforation of the stomach is another of those 
cases in which the course of the disease is very insidious. 
Every now and then a case occurs in which the patient, 
previously in tolerable health, or complaining occasionally 
of some stomachic uneasiness, is suddenly seized with severe 
pain, and dies with all the phenomena of peritonitis. Dis- 
section reveals an ulcerated opening in the stomach. Here, 
an ulcer so small or so little sensitive as scarcely to have 
made itself felt, has opened a way through all the coats, 
and allowed the gastric contents to escape into the peritoneal 
cavity. Another variety of the disease is so peculiar as to 
merit a separate paragraph. 

Under the name of gastrorrhcea, modern writers describe 
an affection, characterized by the copious discharge from 
the stomach of a glairy fluid, usually insipid and inodorous, 
bearing a close resemblance in appearance to the uncoagu- 
lated white of eggs, or of mucus in its ordinary form. The 
vomiting occurs most commonly in the morning, as if the 
fluid had collected in the stomach during sleep ; but it may 
take place at any time ; and a singular- circumstance is, that 
the matter is often thrown off after eating, without a simul- 
taneous discharge of the food. The vomiting is usually 
very easy — sometimes, in fact, little more than a species of 



CHRONIC INFLAMMATION OF THE STOMACH. 293 

regurgitation. The disease may be considered as a sort of 
catarrh of the stomach. It is sometimes attended with the 
ordinary phenomena of chronic gastritis ; but, in other 
cases, neither exhibits during life, nor leaves after death, 
evidences of inflammation. Still, like the similar affection 
of the nostrils and the bladder, it probably originates, even 
in the latter cases, in an inflammatory condition, or at least 
irritation of the mucous membrane, which has given way 
to the discharge, while the secreting vessels retain their 
new mode of acting. It is often a mild disease, but in some 
instances runs a long course, and at last ends fatally, espe- 
cially in old persons. 

Causes. — Chronic gastritis occasionally follows the acute ; 
but, in the great majority of cases, it is an independent 
affection, resulting for the most part from long persisting 
or frequently repeated irritation. The abuse of alcoholic 
liquors, habitual excess in eating, the employment of indi- 
gestible food as ordinary diet, and the excessive use of 
medicines, are among the most frequent causes. Congestion 
of the portal circulation, and the sympathetic irritation 
arising from disease in other organs, especially in the liver 
and spleen, may also give rise to the complaint. It is a 
frequent attendant upon phthisis, especially in the latter 
stages ; and the tuberculous diathesis communicates to it 
an extraordinary obstinacy when it arises from other 
causes. But no disease is so productive of chronic gastritis 
as dyspepsia; and the two affections are so frequently 
associated, that by some authors they are considered 
identical. This subject will be discussed under dyspepsia. 
It is sufficient here to say, that the chronic inflammation 
which so often accompanies or follows that complaint, may 
be ascribed in great measure to the constant irritation of 
the undigested, or badly digested, or chemically altered 
food, and of the acrid and otherwise disordered secretions 
which take the place of the healthy stomachic fluids, in 
consequence of the impaired energy of the organ. 

Diagnosis. — The only complaints with which chronic 
gastritis is liable to be confounded, are cancerous and other 
organic affections of the stomach, gastralgia and analogous 



294 INFLAMMATION. 

nervous affections, and dyspepsia. For the diagnostic cha 
racters in each of these cases, the reader is referred to the 
several diseases mentioned. 

Treatment. — The first and most important indication in 
the treatment of chronic gastritis is the removal of the 
cause. As the disease in most instances either arises from 
irritating ingesta, or is sustained by them, and in all 
instances is aggravated by this cause, it is indispensably 
necessary to subject the patient to strict regulations of 
diet. This, indeed, is often all that is necessary to effect a 
cure. But the same diet is not applicable to all conditions 
of the disease. It is necessary, in regulating it, to have 
reference to the stage and degree of the inflammation, and 
the state of the system. It must be borne in mind, that 
the organ inflamed is that through which the system is 
nourished, and that, although it might be desirable in refer- 
ence to the organ alone to restrict the diet most rigidly, yet 
the general debility may be such as to present still stronger 
claims to observance. Besides, the stomach itself may be 
injured by extreme abstinence, where the system is calling 
for support. Such are the sympathies of this viscus with 
the remainder of the body, that the suffering arising from 
deficient nutriment in every part is reflected upon it with 
especial force, and the stomach may thus be irritated in the 
midst of starvation. In this state of sympathetic suffering, 
its secretions are deranged, and themselves become an addi- 
tional source of irritation. Hence, there is sometimes 
danger from that extreme abstinence upon which some 
authors have insisted ; and patients have rapidly improved 
under a nutritious diet, after a long and fruitless abstemious- 
ness. No precise rule can be laid down for all circumstances, 
except that in every case the food allowed should be of the 
kind most easily digested ; as indigestible food, whether 
highly nutritious or otherwise, acts as a powerful irritant 
to the stomach. When the inflammation borders on the 
acute, and a slight febrile action exists, with a loss of 
appetite, farinaceous or mucilaginous liquids, such as solu- 
tions of tapioca, sago, arrowroot, and gum-arabic, and 
decoction of barley, should be exclusively used. If the 



CHRONIC INFLAMMATION OF THE STOMACH. 295 

disease be quite chronic, and without fever on the one hand, 
or debility on the other, a more nutritious diet may be 
used, consisting of stale bread, crackers, boiled rice, mush, 
and gruels, care being always taken that the solid sub- 
stances should be thoroughly masticated. In cases of 
general debility, the diet may be improved by the addition 
of milk or fresh cream. In -some instances, great advan- 
tage will accrue from restricting the patient to new milk or 
fresh cream exclusively. This is especially useful in the 
cases attended with obstinate vomiting. The milk may, 
under such circumstances, be usefully mixed with one-third, 
or one-half, or an equal bulk of lime-water. I have found 
few means so effectual in relieving this exceedingly un- 
pleasant form of chronic gastritis as the exclusive use of 
such a diet. Patients who for weeks and months have 
scarcely been able to retain a meal, and who have been 
reduced to the lowest state of emaciation, have experienced 
an almost immediate change for the better under this treat- 
ment. A fresh raw egg swallowed whole, and nothing 
taken afterwards for some hours, will often arrest vomiting 
both in acute and chronic gastritis. As the symptoms 
improve, bread or crackers may be used with the milk and 
lime-water, and the latter ingredient may be gradually 
omitted. When the debility is considerable, a more nutri- 
tious animal diet sometimes becomes necessary. Oysters 
raw or roasted, soft-boiled eggs, animal jellies, the white 
flesh of poultry and wild fowl, mutton, venison, etc., may 
be used, the caution being always observed to select only 
those meats which are easily digested. Boiled meats will 
also in general be preferable to those cooked in other modes. 
Of course the diet will be varied in the same case according; 
to the indications ; and it will generally be proper, after 
persevering for a considerable time with a rigid antiphlo- 
gistic regimen, to allow a gradual improvement, as the 
patient is found to bear it. Attention should always be 
paid to the calls of the stomach; and when the patient 
perseveringly demands certain articles of food, even though 
they may seem improper, he should be indulged, cautiously 



296 INFLAMMATION. 

at first, and afterwards freely, should they be found, as 
they often will be, to agree well with the stomach. 

Alcoholic drinks should in all cases be scrupulously 
avoided. Coffee and tea should also be avoided ; at least, 
only black tea should be allowed, and that weak. The 
patient may drink infusion of cocoa, or sweetened milk and 
water, at breakfast and tea. On the whole, however, cold 
water is the best beverage. Whatever drink may be 
allowed, it should be taken in moderate quantities at a 
time, so as not to distend the stomach. 

By the means above mentioned, without the aid of medi- 
cine, cures may often be effected ; but it is necessary to 
persevere long, and to guard the patient against any prema- 
ture relaxation of the dietetic plan. A single debauch, or 
indulgence for a short time in forbidden food, may undo the 
work of months. 

Other remedies, however, will often prove useful as 
adjuvants. Should the local symptoms be severe and the 
pulse strong, blood may sometimes be taken from the 
epigastrium by leeches or cups. Leeches are to be pre- 
ferred, as the pressure of the cups may prove hurtful to 
the stomach. It is usually better to take a small quantity 
of blood, and to repeat the operation occasionally, than to 
exhaust the patient by large numbers of leeches at once. 
Revulsion by means of small blisters over the stomach, 
frequently repeated, or of croton oil or tartar-emetic applied 
so as to pustulate, is often highly useful. Should the 
tartar-emetic, however, sicken the stomach, as it sometimes 
appears to do when externally applied, it should be omitted. 
Costiveness must be obviated by means of laxatives or 
cathartic enemata, [injections,] or both combined. The free 
use of medicines of any kind by the stomach is injurious ; 
but enemata are of themselves scarcely sufficient to meet 
the indication to evacuate the upper as well as the lower 
bowels. The gentlest laxatives should be selected and 
sparingly used. Magnesia is one of the best, as it answers 
the purpose of an antacid, which is often wanted. Rhubarb, 
castor oil, and the seidlitz powder may also be employed. 



CHRONIC INFLAMMATION OF THE STOMACH. 297 

The same end may often be advantageously accomplished 
by a laxative diet of bran bread, or rye mush, or of stewed 
fruits when these are found not to irritate the stomach. 
Attention should be paid to the skin. Frictions with the 
flesh-brush, the warm or hot bath, according to the degree 
of excitement, and flannel next the skin, are all useful. 
From three to five grains of Dover's powder at bed-time 
sometimes answer a good purpose by producing perspira- 
tion, as well as by enabling the patient to sleep. When 
there is great local suffering, with general restlessness, small 
doses of the acetate or sulphate of morphia may be given 
occasionally with advantage ; but care is always requisite 
to avoid establishing an injurious habit, which the patient 
may have difficulty in breaking. The feet should be kept 
warm, if necessary, by rubefacient applications. Other 
diseases, whether functional or organic, and, in the female, 
disorder of the menstrual function, should be relieved by 
appropriate remedies ; regard being always had to the pro- 
bability of injuring the stomach by irritating medicines. 

When the measures above detailed do not answer, espe- 
cially when there is reason to suspect the existence of 
ulcers, recourse may be had to the alterative remedies, 
which prove so useful as local applications in similar affec- 
tions of the mouth and fauces. Sub-nitrate of bismuth, 
the sulphates of iron, zinc, and copper, and the nitrate and 
oxide of silver, have all been usefully employed. The 
nitrate of silver has recently attracted considerable atten- 
tion, and has been given in larger doses than were formerly 
thought advisable. From one-quarter of a grain to a grain 
is often administered two or three times a day without 
disadvantage. Cures in apparently desperate cases are 
sometimes obtained by nitrate of silver thus employed. I 
have repeatedly seen patients rescued by this remedy, for 
whom all other hope had been abandoned. It is generally 
advisable to combine the metallic salts with small doses of 
opium, or one of the salts of morphia. 

Tonics in the advanced stages are sometimes useful, pro- 
bably by giving to the vessels relaxed by the previous 
inflammation sufficient energy to take on a healthy action, 



298 INFLAMMATION. 

and resume their ordinary functions. The chalybeates and 
simple bitters should be preferred. 

In gastrorrhoea, which is often rather a condition conse- 
quent upon previous inflammation than itself inflammatory, 
the treatment by the mineral alteratives above mentioned, 
and by tonics, is peculiarly applicable. Should symptoms 
of inflammation exist, they should be combated in the 
ordinary manner. Should they be absent, the treatment 
may be commenced by an emetic of ipecacuanha followed 
by a saline purgative, as epsom salts or seidlitz powder. 
The vegetable bitters, chalybeates, and mineral acids may 
be used; but most confidence is generally placed in the 
sub-nitrate of bismuth and nitrate of silver, the latter 
remedy being given in the dose of one-eighth to a quarter 
of a grain twice a day. Opium or some one of its prepara- 
tions may be combined with the mineral salts, to relieve 
pain and check secretion. In such cases I have often 
derived great advantage from the following prescription : 
sul. morphia, two grains ; turpentine, one drachm ; muci- 
lage, four ounces ; a teaspoonful every two or three hours. 
The diet should generally be nutritious and digestible, con- 
sisting chiefly of farinaceous substances and animal food. 

During the course of the treatment, in every form of 
chronic gastritis, efforts should be constantly made to pre- 
vent the mind from reacting injuriously on the stomach, 
and at the same time to remove excitement from this organ 
by diffusing it equably over the whole system. Hence the 
importance of regular though not violent exercise, of re- 
laxation from the cares and anxieties of business, and of 
agreeable mental occupation. A complete change of scene 
often proves serviceable. Excursions to different parts of 
the country, visits to the springs and to the sea-shore, sea 
voyages, and a residence or travelling abroad, often prove 
effectual, in cases to which much movement is not inappli- 
cable, in bringing about a cure, or confirming convalescence. 

INFLAMMATION OF THE BOWELS. 

The intestinal tube is seldom if ever inflamed throughout 
its whole extent. Nor are the phenomena or symptoms 



INFLAMMATION OF THE DUODENUM. 299 

which different portions of it present, or the treatment they 
demand, in a state of inflammation, precisely the same. It 
is, therefore, convenient to divide the intestines into dis- 
tinct sections, and to consider the affection in each of these 
separately. It is nevertheless true, that inflammation in 
any one section often spreads, to a greater or less extent, 
into that which adjoins it ; and, in some instances, it would 
be impossible to decide which of the two is most promi- 
nently affected. I shall treat separately of inflammation 
of the upper portion or duodenum, of the middle portion, 
embracing chiefly the small bowels, viz., the jejunum and 
ileum, and of the lower portion or large intestines. 

INFLAMMATION OF THE DUODENUM, OR DUODENITIS. 

The duodenum is liable to the same modes of derange- 
ment as the stomach, and very frequently participates in its 
diseases. This might be expected, as its structure and 
functions so nearly resemble those of the stomach, that it 
has been not inappropriately called the second stomach. 
Thus, the various forms of gastric inflammation and irrita- 
tion, cancer of the stomach, and even that condition of the 
organ denominated dyspepsia, extend in many instances to 
this portion of the bowels. Indeed, the duodenum itself is 
very seldom independently affected. The modifications 
produced either in the symptoms or treatment of stomachic 
disease by this complication are very few ; and even where 
the duodenum may be supposed to be the exclusive seat of 
disorder, the phenomena and indications of cure are so 
similar to those presented by the analogous condition of the 
stomach, that it would be useless repetition to enter into 
minute detail, in relation to the morbid affections of the 
former structure. I shall, therefore, content myself with 
referring merely to the diagnostic symptoms, and to those 
points in the treatment which are in any degree peculiar. 
The circumstance in diseases of the duodenum which most 
deserves notice, is their peculiar tendency to produce func- 
tional disorder of the liver. Diseases exclusively gastric 
have the same tendency, but in an inferior degree. Brous- 
sais appears to have been the first to call attention decidedly 



300 INFLAMMATION. 

to this fact. Among the phenomena of hepatic or bilious 
disorder, accompanying affections of the duodenum, the 
most striking is a jaundiced state of the skin. The mode 
in which this is produced has been variously explained. 
It has been ascribed to a closure of the common duct of 
the liver, which gives passage to the bile and empties into 
this bowel, either by mucus, or a thickening of its coats 
consequent upon duodenal inflammation, and to the absorp- 
tion of the bile thus impeded in its passage to the bowels. 
This explanation may possibly apply to some cases ; but it 
is probably not true in general, and certainly not univer- 
sally; for cases of duodenitis with jaundice occur, in which 
bile freely enters the bowels ; and, in fatal cases, the duct 
has been repeatedly found upon dissection entirely unob- 
structed. A more probable explanation is founded upon 
the observation of Bichat, that between a secreting gland 
and the surface upon which its excretory duct opens, there 
is a sympathy by which a stimulus applied to the latter 
causes an increased action in the former. Thus the stimu- 
lus of food in the mouth causes an increased secretion of 
saliva. In like manner, the presence of the chyme in the 
duodenum stimulates the liver and pancreas, so that an in- 
creased supply of bile and pancreatic fluid, which are useful 
in the process of digestion, may be received where they are 
wanted. Irritation or inflammation of the duodenum 
should, therefore, produce irritation of the liver, which, 
according to its degree, may be attended either with an 
increase or diminution of the secretion of bile. In the for- 
mer case, absorption takes place from the abundance thrown 
into the biliary passages and bowels ; in the latter, the mate- 
rials out of which the bile is formed accumulate in the 
blood ; and, in both cases, the yellow coloring-matter is 
eliminated upon the surface and elsewhere. Again, in the 
dyspeptic or depressed state of the duodenum, it is incapa- 
ble of receiving the ordinary impression from the chyme, 
and the ordinary stimulus is consequently not supplied to 
the hepatic secretory function. In this way also the secre- 
tion of bile is diminished, its materials accumulate in the 
blood, and jaundice results. But, notwithstanding the 



INFLAMMATION OF THE DUODENUM. 301 

occasional dependence of bilious affections upon disease of 
the duodenum, I believe that some authors have pushed 
this view much too far, and given to that viscus a patholo- 
gical importance which it does not merit. Jaundice and 
other bilious symptoms may sometimes result from duode- 
nal inflammation ; but much more frequently they proceed 
originally from the liver, and the duodenum, if at all in- 
volved, is so either secondarily, or simultaneously from 
its exposure to the influence of the same causes. 

Diagnosis. — Duodenitis, when it occurs, is almost always 
associated with inflammation of the stomach or of the 
bowels. Its existence may be suspected when, in addition 
to the ordinary symptoms of gastritis, there is deep-seated 
pain in the vicinity of the pylorus, or lower orifice of the 
stomach, extending below the stomach toward the left 
hypochondrium, or pain in the back about the first or second 
lumbar vertebra; when there is tenderness upon strong 
pressure in the space which lies immediately to the left of 
the right hypochondrium, without any evidence of enlarged 
or inflamed liver ; and when the skin is more or less yellow, 
and the urine bilious, as in jaundice. If these symptoms 
should occur, without vomiting, great thirst, or pain and 
tenderness in the region of the stomach, indicating gastritis ; 
without diarrhoea, pain in the lower bowels, or tympanites 
indicating enteritis ; and without enlargement or tenderness 
of the liver indicating hepatitis, it may be inferred that the 
inflammation is confined chiefly, if not exclusively, to the 
duodenum. In acute duodenitis there is occasionally, along 
with the fever, a degree of coma dependent probably upon 
the hepatic derangement. In the chronic form of the com- 
plaint, a diagnostic symptom is the occurrence of pain two 
or three hours after a meal, arising from the passage of a 
portion of the contents of the stomach into the duodenum. 
The bowels in duodenitis are generally slow, but readily 
acted on by cathartics. 

The causes of duodenitis are essentially the same as those 
of inflammation of the stomach. Such of them, however, 
as act through the liver are probably more influential in 
producing the former than the latter affection. 



302 INFLAMMATION. 

Treatment. — The treatment also is that adapted to gas- 
tritis. If there be any difference, it is chiefly in the freer 
use of mild cathartic medicines, such as the neutral salts, 
bitartrate of potassa, castor oil, senna, etc. ; and when the 
liver is also involved, such remedies as have been directed 
when treating on hepatitis. 

ENTERITIS, OR INFLAMMATION OF THE SMALL INTESTINES. 

The name enteritis is, strictly speaking, applicable to 
inflammation of any portion of the bowels ; yet, as this 
affection, in the upper and lower extremities of the intes- 
tinal tube, has received the designations of duodenitis and 
dysentery, and as the symptoms of these two complaints 
are in certain points strikingly peculiar, it becomes con- 
venient to give a distinct name to inflammation of the 
intervening portion, and enteritis may perhaps, without 
impropriety, receive this more restricted meaning. It 
should be understood, that inflammation of the peritoneal 
coat of the bowels, as a distinct affection, though hitherto 
frequently denominated enteritis, is not here included under 
that term, as it clearly belongs to peritonitis. Enteritis, 
then, as employed in this work, signifies inflammation of 
the mucous membrane of the jejunum and ileum, extending 
frequently to a greater or less distance into the colon, and 
occasionally involving the other coats as a secondary result. 
The force of the disease is usually spent upon the ileum, 
the jejunum being less liable to inflammation than any other 
portion of the alimentary canal. The greater liability of 
the ileum to be affected depends, probably, on that arrange- 
ment by which the fluids, in their passage through the 
bowels, are somewhat impeded at the ileo-csecal valve, and 
commencement of the ascending colon, and thus have the 
opportunity of exercising a more protracted irritant influ- 
ence on this than upon the upper portion of the tube. As 
the inflammation may extend indefinitely into the colon, it 
is obvious that the phenomena of dysentery must often be 
mingled with those of the complaint under consideration ; 
and cases occur, in which it would be impossible to decide 
to which affection they should be referred ; yet, for the 
most part, the symptoms are sufficiently distinctive. 



INFLAMMATION OF THE SMALL BOWELS. 303 



ACUTE ENTERITIS, OR INFLAMMATION IN THE SMALL BOWELS. 

The complaint commonly begins with uneasiness in 
the bowels, followed after a time by occasional slight 
griping pains, which gradually become more frequent and 
severe. In some cases, however, the symptoms are violent 
from the commencement, and in others, again, very little 
pain is felt throughout. There is generally more or less 
tenderness upon pressure. The seat of the pain and tender- 
ness is usually about the umbilicus, though it varies with 
the part inflamed, and is not unfrequently found more 
especially in the right iliac region. 

Diarrhoea is a very frequent symptom. Discharges from 
the bowels are apt to follow attacks of griping pain, which 
they often mitigate ; and several of these discharges may 
occur in the course of a day. The lower in the bowels 
the seat of inflammation, the more liable is it to be attended 
with diarrhoea, and the more frequent, as a general rule, are 
the evacuations. In cases where the bowels are not loose, 
they are for the most part readily and frequently moved by 
very small doses of mild cathartics. Sometimes the diarrhoea 
is suspended and again recurs, and this may happen several 
times during the course of the complaint. The stools are 
usually liquid, consisting of the increased serous exhalation 
of the intestines, mixed with fecal matter, bile, mucus, and 
undigested food, and sometimes tinged with blood. Occa- 
sionally, they are dark or green from the changed bile, or 
clay-colored from the absence of that fluid. There is 
occasionally some flatulent distension of the bowels ; but 
this rarely amounts to tympanites, unless in children. 
When the inflammation depends upon obstruction in the 
bowels, or affects to any considerable extent the muscular and 
peritoneal coats, constipation instead of diarrhoea is experi- 
enced. Sometimes, indeed, the constipation, in inflamma- 
tion involving the whole thickness of the bowel, is extremely 
obstinate, giving rise to vomiting and tympanitic distension, 
so as to resemble cases of obstruction, and sometimes to 
have been mistaken for them, with unfortunate conse- 
quences. 

20 



304 TNFLAMMATION. 

Febrile symptoms sometimes precede those of a local 
character, the sympathies and sensibility of the intestinal 
mucous membrane being such, that its inflammation may be 
felt by the system at large before making itself known by 
pain or increased secretion. In such cases there is general 
uneasiness, languor, and diminished appetite, with alternate 
chilliness and flushes of heat, for some days before the 
occurrence of pain. The fever when established is often 
remittent in character. The pulse is more or less excited 
and usually well developed, the skin dry, the urine scanty, 
and the tongue moist and somewhat furred. There is 
usually little or no headache or delirium. 

The disease is often very mild, running its course in a 
few days, with little fever or pain, and but a slight diarrhoea , 
Even the severer cases, when properly treated, and not 
injuriously complicated, or subjected to the continued action 
of the cause, generally begin to decline in about a week. 
The result, however, is not always so favorable. The pains, 
instead of diminishing, are aggravated ; the flatulent disten- 
sion increases ; the discharges become very offensive ; 
inflammation ascends to the stomach, and vomiting occurs, 
with burning thirst, and epigastric tenderness ; the liver 
sometimes becomes involved, and jaundice is added to the 
other symptoms ; delirium sets in ; the tongue becomes red 
and dry, and the pulse frequent and feeble ; great emaci- 
ation takes place ; and the patient either sinks at last, or 
recovers after a tedious and uncertain convalescence. In 
other cases, the peritoneal coat becomes inflamed, in conse- 
quence either of a direct extension of the disease from the 
mucous coat, or of an ulcerative perforation of the intestine, 
and the escape of its contents into the abdominal cavity. 
This event is marked by the occurrence of symptoms cha- 
racteristic of peritonitis, and is too apt to lead to a fatal 
issue. Acute enteritis also frequently terminates in the 
chronic form. 

Causes. — Among the causes of enteritis may be mentioned 
exposure to cold, especially when in a state of perspiration, 
retrocession of gout, rheumatism, and cutaneous eruptions, 
and the suppression of accustomed discharges. It is pro- 



INFLAMMATION OF THE SMALL BOWELS. 305 

duced also by the direct contact of irritating substances, as 
by articles of food which have passed undigested through 
the stomach, acrid medicines especially drastic purges, 
poisons, hard insoluble bodies which have been swallowed, 
acrid secretions from the stomach, liver, pancreas and 
bowels themselves, worms, and by various causes which 
more or less completely obstruct the bowels, such as feculent 
or other solid accumulations, tumors, strangulation, etc. 
Enteritis is a frequent attendant upon other diseases, 
especially typhoid fever, the eruptive fevers, and consump- 
tion, and is one of the consequences of extensive burns, and 
may arise from the propagation downward of inflammation 
of the stomach. It attacks indiscriminately persons of 
both sexes and all ages, but is probably most common in 
children. 

Diagnosis. — This complaint is distinguished from perito- 
nitis by the want of that intense pain and tenderness, that 
excessive vomiting, that obstinate constipation and tym- 
panites, and that contracted, frequent pulse, so common in 
the latter affection. When these symptoms occur during 
the progress of enteritis, there is reason to believe that the 
inflammation has attacked the peritoneal coat, and if they 
come on suddenly, that the bowel has been perforated. 
Colic is distinguished by the greater severity of the pain 
and its more decided spasmodic character, by the relief 
afforded by pressure, by the constipation which attends it, 
and by the frequent entire absence of fever. Another 
affection with which enteritis might be confounded is rheu- 
matism of the abdominal parietes. But in this the pain 
and tenderness are more superficial; the patient suffers 
extremely from any attempt to move his body ; there is no 
diarrhoea ; and if any febrile action exist, it is much less 
than would attend an equal amount of local suffering from 
enteritis. 

General Treatment. — If the disease is attended with con- 
stipation, a mild cathartic should be given ; a tablespoonful 
of castor oil, with ten or fifteen drops of turpentine, will be 
a good prescription. Even when there is diarrhoea, laxa- 
tives are indicated in order to remove irritating secretions 



306 INFLAMMATION. 

or accumulations. For this purpose castor oil, with lauda- 
num instead of turpentine, answers admirably well, which 
relieves pain without preventing the action of the medicine. 
Magnesia is preferable when there is much acid in the 
bowels, which may often be known by the odor and color 
of the stools. A mixture of magnesia and manna with 
fennel-seed tea forms a very good combination in such 
cases. Throughout the complaint, the bowels should be 
kept open if necessary by these laxatives, or by the neutral 
salts, so that there may be two or three stools daily. Emol- 
lient injections may be substituted if cathartics are found 
too irritating, and in any case may be used to assist them. 
The drastic purgatives should never be employed; and 
much smaller doses of the medicines mentioned will answer 
than under ordinary circumstances. It is also desirable to 
direct action towards the surface. When the skin is hot 
and dry, and the febrile action considerable, the neutral 
mixture or effervescing draught may be employed, com- 
bined, if it irritate the bowels, with a small portion of 
laudanum ; in other cases, the powder of opium and 
ipecacuanha is preferable. This should be given at night, so 
as to procure rest. Calomel or the blue-mass should be 
added in small doses when there is deficiency or derange- 
ment of the hepatic function. The warm bath is also very 
useful, especially in the cases of children. In the advanced 
stages, after the subsidence of fever, and when the indica- 
tion to check diarrhoea exists, the blue powder, [hyd. cum 
creta,] given in small and frequently repeated doses, will be 
found highly useful, particularly in children. But greater 
advantages have been derived from the use of the fever 
syrup than any other remedy ; it must be given in small 
doses in sweet milk or mucilage, and often repeated. Great 
care is requisite in relation to the diet. In very severe 
cases, with much fever, a solution of gum-arabic will be 
sufficient. When something more nutritious is required, 
the farinaceous drinks, such as barley-water, rice-water, 
bread-water, and solutions of arrowroot, sago, and tapioca 
may be given. A little black tea and dry or toasted bread 
may be allowed to patients who crave them. In the 



INFLAMMATION OF THE SMALL BOWELS. 307 

declining stages, weak chicken or mutton broth, without fat 
or vegetables, will sometimes be found useful. 

Local Treatment. — The most efficient local measure is 
leeching immediately over the seat of tenderness. When 
leeches cannot be obtained, cups maybe substituted. Many 
cases, however, require neither. Warm fomentations or 
emollient poultices sprinkled with chloroform liniment 
should be kept constantly applied for days together ; with 
these laudanum or hops may be conjoined ; and advantage 
will sometimes ensue from the addition of a little mustard, 
or other rubefacient. I have found much benefit from 
bruised garlic mixed with emollient cataplasms, especially 
in infantile cases with tympanitic abdomen. When the 
disease is obstinate, a blister should be applied over the 
abdomen. 

When the stomach, liver, or brain becomes involved, 
treatment adapted to the affections of these organs respect- 
ively must be resorted to. In convalescence it is highly 
important to regulate the diet so as to avoid relapses, which 
probably proceed from errors in this respect more commonly 
than from any other cause. The patient should resist his 
frequently strong inclination to eat to excess. The lightest 
and most digestible articles of animal food should first be 
employed, along with easily digestible farinaceous sub- 
stances, and a gradual advance made to more substantial 
aliment. Most of the fresh vegetables and fruits should 
be avoided until health is reestablished. There will be 
much less danger from eating if a teaspoonful of the fever 
syrup is taken after each meal. 

Occasionally, after the complete disappearance of all 
evidences of inflammation, a diarrhoea is left, dependent 
probably upon a relaxation of the secretory vessels or 
orifices, consequent on the previous excitement. In such 
cases, tonics and astringents become usefuL (See Diarrhoea.) 

CHRONIC ENTERITIS. 

This may follow the acute disease, or may be the direct 
result of the same causes, operating with less force, or upon 
a less susceptibility. Diarrhoea is even more characteristic 



308 INFLAMMATION. 

of chronic than of acute enteritis. Most cases of very 
obstinate diarrhoea are in fact nothing more than chronic 
inflammation of the bowels. The frequency, quantity, and 
quality of the stools vary exceedingly. Sometimes the 
number does not exceed two or three in twenty-four hours, 
sometimes the patient enjoys no rest from their recurrence ; 
and this diversity is often found at different periods of the 
same case. The amount discharged is in some instances 
trifling, in others exceedingly abundant. In character the 
evacuations are not unlike those of acute enteritis. Occa- 
sionally portions of false membrane are discharged, and, in 
some rare instances, tubes of considerable length, obviously 
the result of a plastic inflammation, throwing out coagu- 
lable lymph upon the surface of the mucous membrane. 
Such cases are apt to be somewhat tedious, but may never- 
theless do well in the end. In the advanced stages of the 
complaint, the evacuations are sometimes mingled with pus, 
which is an unfavorable sign. There is generally more or 
less pain; and strong pressure, or any sudden jar, as in 
coughing or jumping, occasions uneasiness. Sometimes the 
pain is severe, and, though relieved after each evacuation, 
returns so frequently as to keep the patient in almost con- 
stant distress. In many cases, it comes on at a certain 
period after eating, indicating the time at which the ingesta 
reach the spot affected. The abdomen is sometimes very 
flat, sometimes much distended, and even tympanitic. The 
appetite is often craving, and seldom wholly wanting, 
unless when the stomach participates in the disease. Occa- 
sionally the system scarcely evinces any other signs of 
sensibility to the local affection than a diminution of 
strength, and a more or less rapid emaciation. Generally, 
however, the pulse is somewhat increased in frequency, the 
tongue slightly furred, and the skin dry and harsh. In 
bad and protracted cases the tongue is sometimes red, 
smooth and dry, or aphthous, and the pulse very frequent. 
The spirits are usually depressed, sometimes greatly so, 
the patient being gloomy, morose, or irritable, dwelling on 
nothing but his own suffering, and seeing no hope before 
him. The mental disturbance amounts, in some instances, 



INFLAMMATION OF THE SMALL BOWELS. 309 

to insanity ; and incurable cases of this disease have had 
their origin in chronic enteritis. The stomach not unfre- 
quently participates in the inflammation, and then all the 
symptoms of chronic gastritis are superadded. The dura- 
tion of the disease is exceedingly variable. It may be 
cured within a week or two from the commencement of 
treatment, or may run on for years. When of long duration, 
it generally undergoes numerous vicissitudes, the patient 
being at one time much relieved or nearly well, and then 
again relapsing upon some new exposure, or even without 
obvious cause. Towards the close of fatal cases, hectic 
fever usually takes place, and the patient becomes much 
emaciated. 

The causes are the same as those of acute enteritis. A 
tuberculous diathesis strongly predisposes to the complaint; 
and in very obstinate cases, which cannot be traced to 
cancerous disease of the bowels, or other obvious cause, 
there is great reason to apprehend that tubercles may have 
been developed in the mucous membrane. Chronic enteritis 
is a very common attendant upon the advanced stages of 
consumption. 

Treatment. — The most important part of the treatment is 
probably the regulation of the diet. As the appetite is 
often unimpaired, and sometimes craving, the patient is con- 
stantly tempted to transgress, both in the quantity and 
quality of his food ; and this is one of the chief causes of 
the occasional obstinacy of the complaint. The dietetic 
rules applicable here are so nearly the same with those 
already given under chronic gastritis, that it is unnecessary 
to repeat them. The particular kind of food which, on the 
whole, is most suitable, is milk ; and patients will frequently 
get well without medicine if confined to that article exclu- 
sively. But, as it would thus be very irksome, it may be 
taken with stale bread or water-crackers, or boiled and 
thickened with wheat or rice flour, arrowroot, carrageen 
moss, etc. A decoction of Iceland moss with milk is some- 
times useful, as well by its tonic as its nutritive properties. 
When the debility is considerable, it is necessary to have 
recourse to animal broths, etc. (See Chronic Gastritis.) 



310 INFLAMMATION. 

Occasional leeching may be resorted to with great advan- 
tage. Laxatives are required only when the bowels are 
slow, as sometimes, though rarely, happens ; or when an 
accession of irritation arises from acrid accumulations. 
Opiates are almost always indicated. They prove useful 
by relieving pain, moderating secretion, and quieting that 
excessive action of the bowels which is itself injurious to 
the complaint. Opium may be used in the manner recom- 
mended for acute enteritis, or in small doses combined with 
the various remedies which may be given to meet other 
indications. I have found the camphorated tincture of 
opium [paregoric] an excellent preparation in this com- 
plaint. A teaspoonful of it given three or four times a day 
is, in many cases, the only medicine which will be required, 
in connection with a properly regulated diet. Acid in the 
bowels may be corrected by cretaceous preparations, as in 
the acute form. The comp. syrup of peach leaf (see 
Dysentery) may be used with great benefit in this disease. 
The nitrate and oxide of silver with opium have also been 
highly recommended, and the sulphate of zinc may be 
similarly employed: Oil of turpentine and copaiba some- 
times prove useful through their alterative influence over 
the mucous membranes. They should be given in emulsion, 
and, like the other remedies, combined with an opiate. 
Tar-water is also sometimes useful. In some feeble cases, 
the simple bitters, sulphate of quinia, and the chalybeates 
are serviceable, by imparting a degree of tone to the 
ulcerated and relaxed mucous surface, which is necessary 
to the curative process. 

In conjunction with the above measures, the warm or 
hot bath is highly important, the former being preferred 
when the temperature of the skin is above, the latter when 
it is at or below the healthy standard. In the latter case, 
the warm, salt bath is an admirable remedy. It should be 
given daily, and may sometimes be advantageously repeated 
twice a day. Frictions to the surface are also useful. 
When the symptoms are somewhat acute, a large blister 
may be usefully applied over the whole abdomen ; and a 
small blister near the affected part, frequently repeated, or 



INFLAMMATION OF THE SPLEEN. 311 

kept open by stimulant dressings, will often be found bene- 
ficial in ordinary cases. Pustulation with tartar emetic or 
croton oil may be tried when the complaint is obstinate. 
The patient should always wear flannel next the skin ; and 
a broad flannel roller passed frequently round the abdomen 
is sometimes of service. 

Moderate passive exercise, mental recreation, relaxation 
from business, sea-bathing, a journey into the country, a 
sea-voyage, and a residence abroad, may be resorted to, as 
recommended in chronic gastritis, when the condition of the 
disease, or the circumstances of the patient, do not forbid 
them. 

SPLENITIS, OR INFLAMMATION OF THE SPLEEN. 

This disease comes on with rigors, succeeded by heat, 
thirst, and other febrile symptoms ; there is an anxiety and 
feeling of oppression or tightness about the epigastrium, 
with difficult respiration, often joined with a cough without 
expectoration. The patient complains also of external 
heat, tension, pains in the left side, which sometimes extend 
through the whole region of the abdomen, or shoot through 
the diaphragm, and into the left shoulder. The pains are 
increased on pressure, and are pulsatory, pungent, and burn- 
ing in various degrees. The pulse on the left side is some- 
times partially suppressed, often intermittent, weak, and 
not quick. Tfyere is lassitude and loss of strength, watch- 
fulness, and sometimes delirium ; dyspepsia, heartburn, 
vomiting of green bilious matter, and sometimes difficulty 
of voiding urine, from an affection of the kidney or blad- 
der ; swelling in the region affected, representing the form 
of the spleen ; faintings, and bleeding from the nose : but 
the most remarkable symptom which attends, is the bloody 
vomiting, which most authors have considered as peculiar, 
and have designated by various names. By the ancients it 
was termed atra bilis. At the commencement, the intes- 
tines are rather confined, but they soon become relaxed, 
and emit substances somewhat colored by black blood. 

Like the liver, the spleen is often attacked with chronic 
inflammation, and in time becomes enlarged and indu- 



312 INFLAMMATION. 

rated. Sometimes suppuration ensues, and forms an ab- 
scess. 

The causes of the disease are most generally the same 
with those of other inflammatory diseases ; but enlarge- 
ments of the spleen are frequently the consequence of long- 
continued intermittents ; and these, as well as indurations 
of the liver, are called ague-cakes. They arise, no doubt, 
from too great a determination of blood to these viscera 
during the several attacks of the cold fits. 

With respect to the prognosis in splenitis, it need only 
be observed, that, like other inflammations, it may termi- 
nate either in resolution, suppuration, or scirrhus. Some- 
times it is carried off by a vomiting of dark-colored matter, 
resembling coffee-grounds ; sometimes by a diarrhoea, and 
sometimes by a hemorrhage from the hemorrhoidal vessels. 
The vomiting of grumous matter is, under common circum- 
stances, to be considered a favorable and critical evacuation, 
yet it sometimes proceeds to a fatal excess. Where spleni- 
tis terminates in suppuration, and the contents of the 
abscess are evacuated in the cavity of the abdomen, the 
event may prove fatal; but simple enlargement of the 
spleen often continues many years without much annoyance 
or danger. 

The general treatment of inflammation of the spleen 
should be the same as that recommended for the same grade 
of inflammation of the liver — to which I refer the reader — 
viz.: the fever syrup; the mild purgative pill, assisted 
by salts or seidlitz powder ; chloroform liniment, poultices, 
etc. But there is one remedy which I have found to exert 
great power over this disease, which has not been men- 
tioned, especially in cases of enlargement ; that is, full doses 
of chloride of sodium or common table-salt. In order that 
it may have its full effect, it should be given in the morn- 
ing, when the stomach is empty. My manner is to pre- 
scribe a full tablespoonful dissolved in a glass of cold water, 
to be taken every morning, fasting. If there be foulness 
of the stomach, it will act as a vomit, but it rarely does so 
after the first morning. I have cured many old cases of 
enlargement of the spleen by this remedy alone ; but it is 



INFLAMMATION OF THE KIDNEYS. 313 

better to give a tablespoonful of the fever syrup after each 
meal, in order to improve the general health. If the case 
proves stubborn, a blister over the enlargement should be 
applied, and repeated until the disease yields. 

NEPHRITIS, OR INFLAMMATION OF THE KIDNEYS. 

Nephritis, properly considered, appears to be of two 
kinds : the one arising from the general causes of inflam- 
mation, and being seated principally in the external mem- 
brane of the kidney; the other occasioned by the stimulus 
of gravel or a stone in the pelvis of it, and the inflamma- 
tion occupying the interior parts. It is, however, only the 
first of these that I mean here to investigate ; the other will 
be noticed under the head of Calculus. 

This species of inflammation may be distinguished from 
the colic, by the pain being seated very far back, and by 
the urine being of a deep-red color, voided frequently, and 
in small quantity at a time ; and it. may be known from 
rheumatism, as in nephritis the pain is not much increased 
by the motion of the body. - 

It is to be distinguished from a calculus in the kidney or 
ureter, by the symptoms of fever accompanying or imme- 
diately following the attack of pain, and these continuing 
without any remarkable intermission ; whereas, in a calcu- 
lus of the kidney or ureter, they do not occur until a con- 
siderable time after violent pain has been felt. 

Nephritis is to be distinguished from lumbago by the seat 
of the complaint, discovered upon pressure ; by the dysuria 
and micturition, by its being frequently attended with 
vomiting, and by the pain extending along the course of 
the ureter, and not being much increased on motion, or by 
an erect posture. 

The causes which give rise to this species of nephritis 
are, external contusions ; strains of the back, acrids con- 
veyed to the kidneys in the course of the circulation, vio- 
lent and severe exercise, either in riding or walking, 
exposure to cold, and sand or stone in the kidney. Intem- 
perance is the most fruitful source of the disease, and the 



314 INFLAMMATION. 

use of medicines which strongly stimulate the kidneys is 
also a frequent cause. 

An inflammation of the kidney is attended with a sharp 
pain on the affected side, extending along the course of the 
ureter ; and there is a frequent desire to make urine, with 
much difficulty in passing it ; the bowels are costive ; the 
skin dry and hot ; the patient feels great uneasiness when he 
endeavors to walk or sit upright ; he lies with most ease on 
the affected side, and is incommoded with nausea and 
vomiting, and there are often colic pains. 

In forming an opinion as to the event, we are to draw 
our conclusion from the severity of the symptoms, and 
from the quantity and appearance of the urine which is 
voided. When the disease is protracted beyond the seventh 
or eighth day, and the patient feels an obtuse pain in the 
part, has frequent returns of chilliness and shiverings, there 
is reason to apprehend that matter is forming in the kidney, 
and that suppuration will ensue. Remission of pain, fever, 
and tension, followed by a copious secretion of high-colored 
mucous urine, universal diaphoresis, or a flow of blood 
from the hemorrhoidal veins, are favorable symptoms. 

The terminations of nephritis are of the same nature as 
other inflammations. In slight and favorable cases, resolu- 
tion may be obtained ; but where the disease has continued 
with considerable violence for upwards of a week, suppura- 
tion may be apprehended. It may happen, however, that 
when the disease has been kept down by proper remedies, 
resolution may take place much later than seven days.. It 
is marked by the disappearance of the fever and all the 
symptoms. Suppuration is marked by a remission of the 
pain, with rigors, throbbing, and hectic fever ; in some 
cases, pus is discharged with the urine. 

Nephritis has been known to terminate in gangrene ; but 
this is very rare. The occurrence is characterized by a 
sudden cessation of the pain after it had long resisted every 
remedy; with sinking of the pulse, cold sweats, etc., as in 
other cases of gangrene. 

Another termination of the disease is scirrhus, or enlarge- 



INFLAMMATION OF THE KIDNEYS". 315 

ment and hardening of the kidney. Sometimes nephritis 
gives rise to gravel complaints, probably from extravasated 
blood, or lumps forming a nucleus. 

In the cure of nephritis our chief reliance is to be placed 
on local remedies, such as dry-cupping or leeching over the 
region of the kidneys, assisted by fomentations, chloroform 
liniment, the use of a warm bath, and emollient clysters, 
etc. 

After leeching, etc., we may advise flannel cloths wrung 
out of a warm decoction of emollient herbs, or a bladder 
filled with warm water, to be kept constantly applied over 
the part which is painful ; and, by way of internal fomen- 
tation, an emollient clyster may frequently be injected. 
The patient is at the same time to be directed to drink 
plentifully of mild diluents, such as barley-water, thin gruel, 
whey, linseed or marshmallow tea, etc. 

The intestines are to be emptied by gentle aperients, 
employed as frequently as the occasion may require, in 
addition to emollient clysters, as constipation ought carefully 
to be guarded against. 

Should these means have been adopted without affording 
relief to the patient, he ought then to be put frequently 
into a warm bath, continuing him in it for about fifteen 
minutes each time. The remedy will produce a powerful 
determination to the surface of the body, and greatly in- 
crease the action of the cutaneous exhalants. 

Mild diaphoretics, such as wild sage or balm tea, com- 
bined with sub-nauseating doses of tartarized antimony, will 
at the same time be proper. 

Opiates may be used occasionally to soothe pain, and 
may be added to the clysters. 

In nephritis the application of blisters would be improper. 
They are apt to affect the urinary organs, and to occasion 
much irritation, and would consequently increase the inflam- 
mation. 

It has been mentioned that a difficulty of making water 
is one of the symptoms attendant on this disease : to obvi- 
ate it, some practitioners give heating diuretics, such as 
turpentine, balsams, etc. The practice seems very im- 



316 INFLAMMATION. 

proper, and ought not to be followed, as it will be more 
advisable to apply warm fomentations over the region of 
the bladder and kidney, to eject emollient clysters with an 
addition of opium, and to make the patient drink frequently 
of warm diluents. 

A decoction of the leaves of the peach tree, (Amygdala 
Persica, Linn.,) drunk in the quantity of a pint a day, has 
been found a very useful remedy in many cases of nephritis. 

When the urine deposits a quantity of muco-purulent 
matter, showing that the inflammation has terminated in a 
suppuration, or that an ulcer has already formed in the 
kidney, the balsams and the turpentine may be used with 
advantage ; the best I have tried is fat pine chopped up 
and put in whiskey. 

One of the best medicines, however, with which I am 
acquainted, in such cases, is the uva ursi, which may be 
given in doses of half a drachm, or a drachm, three times 
a day. I have tried it in many instances, and in general 
with a happy effect. 

Where an inflammation of the kidney has arisen from the 
stimulus of a stone or large piece of gravel lodged there, we 
should have recourse to the exhibition of anodynes and 
opiates in considerable doses, both by the mouth and by 
clyster, together with the other mean's advised under these 
particular heads. 

In renal hemorrhage, as well as in most other internal 
hemorrhages, alum as an astringent, and the acetate of lead 
and digitalis as sedatives, are the remedies chiefly to be 
depended upon. 

In nephritis every kind of food which is of a stimulating 
nature ought carefully to be avoided, and such only as is 
lenient and nutritive should be used, as every thing which 
is heating or acrid proves a stimulus to the kidneys ; even 
the fever syrup often causes increased distress in passing 
urine, and has not been prescribed as suitable in this disease. 
Emollients and thin liquors should be drunk plentifully, and 
the patient should take frequent small draughts of them 
notwithstanding the vomiting, as nothing so safely abates 
the inflammation, after proper evacuation, as copious dilution. 



INFLAMMATION OF THE BLADDER. 317 

Those who are liable to frequent returns of the disease, 
or to obstructions in the kidneys, ought carefully to avoid 
getting wet in the feet ; as likewise all exposures to cold ; 
they ought to lie on a mattress in preference to a feather- 
bed ; their exercise should be moderate, and they should 
use no kind of wine or spirits. 

CYSTITIS, OR INFLAMMATION OF THE BLADDER. 

Tension and pain over the pubes, with a frequent desire 
of making water, difficulty in voiding it, or a total suppres- 
sion, together with tenesmus and fever, mark this disease. 

It is seldom a primary affection, but arises in consequence 
of inflammation in the neighboring parts. It is sometimes, 
however, occasioned by a suppression of urine and conse- 
quent over-distention of the bladder, or by a stone of con- 
siderable size lodged in it. 

The treatment advised in nephritis, to which I beg leave 
to refer the reader, w T ill be proper here, except that we 
should not give liquids in great quantities, lest we distend 
the bladder beyond what it is capable of bearing. 

In consequence of previous inflammation from some excit- 
ing cause, the mucous membrane of the bladder now and 
then becomes thickened, indurated, or ulcerated ; and a 
considerable quantity of mucus mixed with pus passes off 
with the urine, giving to it the appearance of whey, and 
now and then blood is discharged. 

In the treatment of such cases, we are to prevent any 
collection of faeces in the rectum by means of some cooling 
laxative taken from time to time ; to abate pain by small 
doses of opium, and to inject the bladder two or three times 
a day with warm water, or some emollient decoction, by 
means of an elastic gum catheter. 

PERITONITIS, OR PERITONEAL INFLAMMATION. 

As the peritoneum is a highly vascular and sensitive 
membrane, forming a covering for all the contents of the 
abdomen and pelvis, it is subject to many causes of inflam- 
mation, which is apt to assume a very active form, and 
requires to be promptly treated. 



318 INFLAMMATION. 



ACUTE PERITONITIS. 

Symptoms, Course, etc. — A chill is sometimes the first 
symptom of peritonitis ; but perhaps more frequently the 
disease begins with pain ; and occasionally the occurrence 
of the two phenomena is simultaneous. The pain is sharp 
and very severe, and usually commences in the lower part 
of the abdomen, in the hypogastric or one of the iliac 
regions, whence it gradually extends over the whole cavity. 
Sometimes it is changeable, occurring now in one spot and 
then in another, and not unfrequently is attended with a 
sense of heat or burning. The abdomen is always tender 
to the touch. The slightest pressure by the hand occasions 
exquisite pain, and whatever gives rise to contraction of 
the abdominal muscles has the same effect. Hence the 
patient suffers much from vomiting, the act of defecation, 
the discharge of urine, and straining of all kinds. A deep 
inspiration is often very painful. Movements of the body 
in or out of bed are also painful ; and even the weight of 
the bedclothes is often insupportable. Hence the patient 
usually lies motionless upon his back, with his knees drawn 
up, so as at once to relax the abdominal muscles, and take 
off the weight of the coverings. Another object of the 
supine position appears to be, to obviate in some degree the 
pressure of the bowels upon the parietal peritoneum. But 
this posture is not so universal as might be inferred from 
the descriptions of most medical writers. The author 
recollects that, in one of the worst cases of peritoneal 
inflammation he ever witnessed, the favorite position of the 
patient was upon his left side, with the knees so much 
drawn up as to be almost in contact with the abdomen. 
Most frequently the tenderness is general, but in some 
instances is greatest in particular spots, and in others is 
confined altogether to one spot; indicating, in the latter 
case, j:he local existence of the inflammation. From near 
the commencement there is generally a feeling of hardness, 
tension, and elasticity in the abdominal parietes ; and very 
soon a tumefaction begins, which increases with the progress 
of the complaint. 



ACUTE PERITONITIS. 319 

This disease presents various diversities of form, and is 
sometimes entirely local, affecting some one portion of the 
peritoneum only ; and this is apt to be the case when the 
disease proceeds from a local cause, such as mechanical 
violence, ^r the inflammation of an invested organ. In 
such cases it frequently happens that, though the inflamma- 
tion is not propagated to any great extent continuously, it 
affects the portion of membrane opposed to and in contact 
with that inflamed. The inflammation is thus more likely 
to be confined to one spot when a fixed than when a mov- 
able organ is affected. Any part of the abdomen where 
there is peritoneum may be the seat of the affection. It is 
scarcely necessary to say, that in these cases all the symp- 
toms, both local and constitutional, are less violent than in 
general peritonitis. The local character of the affection is 
marked by the limited extent of the pain and tenderness, 
though it must be confessed that, in some instances, it 
would be very difficult to establish a certain diagnosis. 
The symptoms are much modified by the position of the 
inflamed membrane, and by the organ which it may invest. 
Thus, when the inflammation occupies the peritoneal cover- 
ing of the liver, it not unfrequently happens that the skin, 
eyes, and tongue are more or less yellow, in consequence 
of an extension of irritation into the substance of the 
organ. Great epigastric pain and tenderness, with severe 
constitutional symptoms, mark the peritoneal inflammation 
of the stomach; obstinate constipation, with a lower seat 
of pain, that of the boivels; painful irritation with tender- 
ness in the hypogastric region, that of the bladder. The 
omentum may be separately inflamed, in which case the pain 
extends over the front of the abdomen, and effusion into 
the folds of the membrane may occasion circumscribed 
swellings, perceptible to the touch, and liable to be mistaken 
for enlarged spleen, or ovaries, or scirrhous tumors of 
different portions of the bowels. Andral mentions, as 
characteristic of pelvic peritonitis, pain above and behind 
the pubes, and extending backwards towards the loins, 
tenderness in the hypogastrium, slight fever, sweats, and 
the formation of tumors in the cavity, which press on the 
21 



320 INFLAMMATION. 

neighboring organs, as the rectum, vagina, and bladder, 
materially interfering with their functions. Another frequent 
seat of partial peritonitis is the right iliac region. This, 
however, is almost always secondary, depending either 
upon the propagation of inflammation from the exterior 
cellular tissue, or from the caecum or appendix, or upon the 
direct irritation of matters which have escaped from these 
portions of the alimentary canal by ulceration. It is 
marked by great tenderness and tumefaction over the head 
of the colon, and by obstinate constipation, and frequently 
terminates in an abscess, which makes its way to the 
surface, either anteriorly, or in the lumbar region. Other 
instances of local peritonitis are those in which the inflam- 
mation depends upon strangulation of the bowel, whether 
from hernia, intussusceptio, or other cause. In these cases, 
the symptoms of inflammation are always preceded by 
those of obstruction in its earlier stages, and subsequently 
associated with those of the same affection in its advanced 
stages, such as almost insuperable constipation, and vomit- 
ing of stercoraceous matter. (See Obstruction of the 
Bowels.) Partial inflammation sometimes becomes general, 
and may thus prove very dangerous ; but when confined to 
its original seat, it generally yields to proper treatment, 
unless complicated with some other more serious affection. 
As in the general disease, it occasionally gives rise to 
collections of pus, which is retained by adhesions between 
opposite surfaces of the membrane, and makes its way by 
ulceration either to the surface of the body, or into some 
one of the hollow viscera, occasionally producing, in its 
passage, much destruction of the organs with which it may 
come in contact. 

Though for the most part an exceedingly painful disease, 
peritonitis sometimes comes on very insidiously, with little 
pain, and no great degree of tenderness, and runs its whole 
course, even to a fatal termination, without being suspected. 
This form of the disease is most apt to occur in persons of 
feeble health, and as a complication of other acute diseases, 
which serve to mask it. 



ACUTE PERITONITIS. 321 

Another modification of peritonitis is that resulting from 
the perforation of a hollow viscus or cavity, and the escape 
of its contents into the peritoneal sac. The inflammation 
is in this case most frequently general, though it may also 
be local. 

Puerperal peritonitis is still another variety of this affec- 
tion. It attacks women in child-bed, usually within three 
or four days after delivery, and sometimes within twenty- 
four hours. The pain sometimes comes on gradually and 
almost insensibly, sometimes suddenly and with severity, 
and in many cases is subject to exacerbations, resembling 
after-pains, with which it has often been confounded. It 
almost always commences in the hypogastric and lumbar 
regions, and, after the whole abdomen has become involved, 
is apt to be felt most severely in those parts. The tender- 
ness on pressure is also at first confined to the region of the 
uterus. The lochia are diminished or suppressed ; the 
mammae become flaccid ; and the secretion of milk either is 
not established, or is suspended if it had commenced. The 
abdomen is soft and flaccid at first, and, though it ultimately 
swells and becomes tympanitic, the parietes have none of 
that elastic tension, which is found in ordinary peritonitis, 
probably owing to their great distention in advanced preg- 
nancy. The effused liquid is often copious, so that fluctua- 
tion in the abdomen is readily perceived. It is unnecessary 
to repeat an account of the general symptoms, which are 
essentially the same as those of ordinary peritonitis, though 
usually more severe. The pulse is more frequent, the 
respiration more hurried, the countenance more deeply 
affected, the prostration of strength greater, and the march 
of the disease more rapid and fatal. Severe pain in the 
head, vertigo, and delirium are more frequent, and cough is 
a common attendant of the puerperal affection. Death, 
which in the severe cases occurs in the course of a few 
days, and sometimes in less than twenty-four hours, is pre- 
ceded by symptoms of great prostration ; an extremely 
rapid and feeble pulse, cold skin, a brown and dry tongue, 
sordes about the teeth, tympanitic abdomen, and discharges 



322 INFLAMMATION. 

of black or dark-green matter by vomiting and stool. 
There is reason to believe that puerperal peritonitis is 
sometimes a secondary affection, in the same manner as 
erysipelas, being dependent upon or at least associated with 
a malignant febrile state of system, of which one of the 
characters is a depraved condition of the blood. In such 
cases, the general actions are feeble almost from the com- 
mencement, and the state of the system is similar to that 
which occurs in malignant typhus. This form of the dis- 
ease, the only one to which the name of puerperal fever 
can be attached with propriety, is most apt to result from 
epidemic influence. 

Peritonitis is always a dangerous disease ; but when it 
occurs in a person of good constitution, and without compli- 
cation, generally yields to early and efficient treatment. 
That form of it which depends on perforation is the most 
fatal. Next, perhaps, in degree of danger, is the puerperal 
peritonitis. The inflammation is least dangerous when it 
is partial, and, as a general rule, when it results from 
external injury. 

Causes. — Peritonitis may arise from the ordinary causes 
of inflammation, such as vicissitudes of temperature, exces- 
sive use of stimulating food or drink, suppression of habit- 
ual discharges whether healthy or morbid, retrocession of 
cutaneous eruptions, and translation of gout and rheuma- 
tism. It is, however, more frequently the result of local 
violence, as of blows, falls, and bruises of all sorts, and of 
wounds penetrating the peritoneal cavity, including various 
surgical operations, among which may be mentioned that 
for strangulated hernia and for tapping, and the Caesarian 
section. 

Sometimes it occurs secondarily to other diseases, espe- 
cially to inflammation of the organs which receive a com- 
plete or partial covering from the peritoneum. Inflamma- 
tion of the womb, whether occurring from violence to that 
organ, or injury received in the process of parturition, is 
said frequently to extend to the peritoneal membrane. The 
disease is an ordinary result of strangulation of the bowel, 
both internal and external, when not relieved. Among the 



ACUTE PERITONITIS. 32 



O 



most frequent causes of it is perforation of the different 
hollow viscera of the abdomen, or of morbid cavities, allow- 
ing the escape of their contents into the peritoneal sac. 
This perforation may be produced by ulceration, by mortifi- 
cation, and the separation of sloughs, or by mechanical 
rupture depending upon an extraordinary distending force 
within the cavities, or weakening of their parietes. Thus, 
perforation of the stomach, bowels, gall-bladder, biliary 
ducts, urinary bladder, kidneys, and ureters ; the opening 
of abscesses in the substance of the organs, or in the cel- 
lular tissue without the peritoneum; the discharge of 
tubercles ; the rupture of distended cysts or of aneurisms, 
may all occasion peritonitis. This perforation of the ali- 
mentary canal is most frequent in the course of typhoid 
fever and of phthisis, in both of which affections ulceration 
of the mucous membrane of the bowels is very common. 
It is also not unfrequently produced by foreign bodies 
lodged in some portion, of the canal, especially in the 
caecum and appendix, where they occasion inflammation, 
ulceration, and ultimately perforation of the coats of the 
bowel. Peritonitis sometimes comes on in the course of 
other diseases, particularly those of a febrile character, 
without any assignable cause, imitating, in this respect, the 
inflammation of various other parts or organs. 

Of the variety of peritonitis denominated puerperal, the 
cause is probably in many instances a propagation of in- 
flammation of the substance of the uterus, or of its veins 
or absorbents, to the peritoneal covering, or the direct par- 
ticipation of that covering in violence done to the organ. 
The disease may also arise from irregularities of diet, vicis- 
situdes of the weather, etc., as any other inflammation. 
But very often also it arises from a peculiar epidemic influ- 
ence, or, as some believe, from contagion ; and thus origi- 
nating, assumes not unfrequently its most malignant form. 
Of this character is the puerperal peritonitis of hospitals 
and lying-in establishments, which has often proved so 
fatal, and so little under the control of remedies. It has 
been asserted that peritonitis in the male has sometimes 
also occurred epidemically. 



324 INFLAMMATION. 

Diagnosis. — When the disease is well developed, and 
attended with the usual symptoms, without complication, 
there can be little difficulty in its diagnosis. From colic of 
all kinds it may be distinguished by the great tenderness 
upon pressure, the more persistent and less paroxysmal 
pain, and the almost constant supine position of the patient ; 
from mucous gastritis and enteritis by the sharper pain and 
greater tenderness, the elastic tension of the abdomen, the 
supine position, the greater tendency to constipation, the 
small and very frequent pulse, the sunken and anxious coun- 
tenance, and generally the deeper impression upon the consti- 
tution \ from inflammation of the muscular coat of the bowels, 
by the more decided colicky symptoms of this affection in 
its earlier stages, its excessively obstinate constipation, and 
the fecal vomiting which attends its close ; from inflamma- 
tion of the liver, bladder, and other parts more or less in- 
vested by the peritoneum, by the absence, in these affec- 
tions, of the symptoms which characterize peritonitis, while, 
if the membrane is inflamed, the acute pain, tenderness, 
abdominal tension, position, pain upon movement, etc., 
serve to indicate the fact ; from rheumatism of the abdomi- 
nal muscles, which bears to it the closest local resemblance, 
by the vomiting, the febrile symptoms, the peculiar expres- 
sion of the face, and the difference in the pain which 
attends motion in the two cases, the pain in rheumatism 
being much severer from voluntary movements, which call 
the muscles into contraction, than from passive movement, 
while both occasion severe suffering in peritonitis. The 
distinction between the inflammation of the peritoneal in- 
vestment of an organ and the substance of the organ itself, 
is often rendered difficult by the fact, that the functions of 
the organ are almost always more or less deranged, when 
the investing membrane only is inflamed ; and, in fact, the 
two affections are often simultaneous ; but an accurate 
diagnosis is of less consequence, as the treatment required 
by the peritoneal inflammation would in general involve 
that required by the inflamed organ, and, when the symp- 
toms are violent, and the diagnosis doubtful, the measures 
required by the more dangerous affection should be adopted. 



ACUTE PERITONITIS. 325 

There is sometimes danger of confounding with peritonitis 
a peculiar nervous affection of the contents of the abdomen and 
pelvis, occurring especially in females. This is often attended 
with severe pain, tenderness, tumefaction, vomiting, and 
frequent pulse. But the pain is less constant ; and, though 
aggravated by slight pressure, is sometimes alleviated when 
the pressure is strong. It is, moreover, often quite paroxysmal. 
The patient is liable to various nervous derangements of an 
hysterical character ; and is able and disposed to change 
position in bed. The pulse and countenance are less dis- 
turbed ; the urine, instead of being scanty, is usually copi- 
ous and pellucid ; and not unfrequently pressure upon the 
spine, by the suffering it occasions, at once discloses the 
nature of the disorder. In all cases of abdominal disease, 
the friction sound under auscultation may be considered, 
when it occurs, as a certain sign of peritonitis ; though it 
does not always attend this disease. 

Treatment. — You must recollect that this is a formidable 
disease, and must be vigorously met by proper remedies, or 
the patient will be lost. The bowels must be freely moved, 
and there is nothing better for this purpose than castor oil 
and turpentine; a tablespoonful of oil with twenty drops of 
turpentine should be given, and repeated in two or three 
hours if the bowels are not freely moved. If the patient 
cannot take oil, salts or senna may be given instead. While 
this is being done, a large poultice freely sprinkled with 
chloroform liniment should be applied, or cloths wrung out 
of hot water will do about as well as the poultice, and are 
less trouble and less apt to annoy the patient ; they should 
be frequently renewed, each time rubbing the surface with 
the liniment, or with camphor and laudanum, or turpentine 
and spirits of hartshorn, or with turpentine alone. As soon 
as the bowels are moved, a full dose of opium should be 
given, and repeated often enough to keep the patient under 
its influence. I usually commence by giving two grains of 
opium, or one of morphine, and then give Dover's powder in 
doses of two or three grains every hour ; but if this vomits, 
paregoric or Bateman's drops may be used instead; from 
half to a full tablespoonful of these may be given every 



326 . INFLAMMATION. 

hour or two hours, in some mild tea or in cold water. 
Recollect that the pain must be allayed, and as much 
opium, or its preparations, must be given as will do this, 
•irrespective of the quantity : for what would barely do this 
in one case might be a dangerous dose in another case, so 
that it is best to begin with a reasonable dose and repeat it at 
short intervals until the proper effect is obtained, and then 
continue it in the quantity that has been found to be neces- 
sary. I have before given the signs by which it may be 
known when the system is fully brought under the influence 
of opium; but in this case the criterion is to give it until 
the patient becomes easy. If the poultice and liniment 
should fail to remove the tenderness of the abdomen, you 
may resort to the use of warm water continuously poured 
upon the naked abdomen ; this is a powerful remedy, and 
will succeed when all others appear to fail ; but it must be 
done perseveringly in order to prove effectual. I was once 
in attendance upon a lady who had peritonitis in a most 
violent degree ; her abdomen had enlarged to the dimensions 
of pregnancy at the full term, she was perfectly unconscious, 
and, to all appearance, near death ; in conjunction with 
another physician, warm water poured upon the abdomen 
was resolved on, and it was continued without intermission 
for about six hours before perceptible amendment was dis- 
covered; she then seemed to awake asofrom a sleep, and 
the disease, in all its phases, gradually gave way. But the 
same effect can generally be produced by an apparently very 
different measure, viz. : by cold water applied by means of 
the wet sheet ; but, though seemingly so different, these 
means operate upon the same principle, viz. : they both 
reduce the heat, relax spasm, and produce a revulsion to 
the surface. If cold is resorted to, it must be managed, 
right, in order to be beneficial : a sheet should be folded 
several times and then saturated with cold water and laid 
on the abdomen, or wrapped entirely round the body; a dry 
blanket must be spread over this, and hot rocks or bricks 
placed to the feet and to the knees ; the hands should also 
be laid upon hot rocks or bottles of hot w T ater. When 
reaction takes place, if the patient becomes restless, the 



INFLAMMATION OF THE BRAIN. 327 

sheet must be wet again, and this should be repeated until 
quiet and ease are obtained, and the patient falls into a 
pleasant slumber and gently perspires ; the end is now 
gained, and nothing further should be done until symptoms 
of returning excitement and restlessness return. By these 
means, vigorously pursued, the most active inflammation, 
whether seated in the peritoneum or any other internal part, 
can be more speedily and more effectually controlled, than 
it ever was by the old method of bleeding to fainting and 
other active depletory measures ; and the patient's strength 
not exhausted, but left in full vigor to aid in bringing about 
a speedy convalescence. After the violence of this disease 
has been subdued by these means, the turpentine emulsion, 
recommended in gastritis, may be given with good effect ; 
and if there still remains considerable evidence of disease, a 
large blister should be drawn, and dressed with the mush 
poultice. 

PHRENITIS, OR INFLAMMATION OF THE BRAIN AND ITS MEM- 
BRANES. 

Phrenitis is an inflammation of the parts contained in the 
cavity of the cranium, and may affect either the membranes 
of the brain, or the brain itself. It is called primary, or 
idiopathic, when it exists independent of any other disorder; 
and symptomatic when it arises in consequence of some 
other disease, as fevers and inflammatory affections ; which 
species is that most universally met with, the other occur- 
ring but very seldom, at least in this country. In warm 
climates, it appears to be sometimes produced by exposure 
to the intense rays of the sun, and often proves quickly 
fatal. 

Its characteristics are vehement fever, severe pain in the 
head, redness of the face and eyes, intolerance of light and 
sound, watchfulness, and violent delirium. 

The causes which give rise to idiopathic frenzy are such 
as directly stimulate the membranes or substance of the 
brain, or increase the impetus of the blood in its vessels ; 
hence violent fits of passion, intense study, excessive 
venery, severe exercise, external violence of any kind, such 



328 INFLAMMATION. 

as blows on the head, an immoderate use of vinous and 
spirituous liquors, a long-continued exposure to the heat of 
the sun, and the suppression of accustomed evacuations, as 
piles, menses, issues, milk drying up, etc., may be regarded 
as the remote causes. Many acute diseases, and a long 
want of sleep, may give rise to symptomatic frenzy. 

The idiopathic is usually preceded by long-continued and 
almost constant watching, or frightful dreams, acute pains 
at first in the neck and back of the head, afterwards 
extending to the cerebrum, deep respiration, inability to recol- 
lect circumstances which have lately happened, suppression 
of urine, and irregular pulse. As the disease advances, the 
eyes sparkle, and are violently agitated ; there is a ferocity 
in the countenance, with universal restlessness, deafness, 
great confusion of ideas, violent ravings, intolerance of 
light, evident pulsation in the temporal and carotid arteries, 
and the most furious delirium. The tongue is dry, rough, 
and of a yellow or black color ; the face is of a deep red ; 
and the pulse is small, quick, and hard. 

The symptomatic frenzy is constantly preceded by acute 
fever, or some inflammatory complaint, and is usually 
accompanied with inability to sleep, constant watching, 
delirium, picking at the bed-clothes, redness and fierceness 
of the eyes, wild look, and deep breathing. 

Phrenitis is distinguished from mania by the quickness 
of the pulse, and the attendant fever and pain in the head ; 
and from that species of delirium which occurs in low fevers, 
unaccompanied with inflammation, by the appearance of the 
countenance and eyes, for in true frenzy the face is red, 
the features are rather enlarged than shrunk, and the eyes 
protrude and sparkle ; whereas, in the delirium supervening 
to low fever, the face is pallid, the features are shrunk, and 
the eyes pearly. It is to be distinguished from inflamma- 
tory fever by the state of the pulse, as in the latter it is 
strong and full, whereas in the former it is small, hard, and 
more rapid. In phrenitis, the delirium is the primary affec- 
tion, but in the other it is consequent upon the general 
fever. 

Phrenitis, whether idiopathic or symptomatic, may always 



INFLAMMATION OF THE BRAIN. 329 

be regarded as a dangerous and alarming complaint ; it often 
proves fatal between the third and seventh day ; and, if long 
protracted, is apt to terminate in mania, or great prostration 
of strength ; it often terminates in stupor and insensibility. 
In children, an effusion of water between the membranes 
of the brain, or in the cavities of its ventricle, is a frequent 
consequence. Grinding of the teeth, white or ash-colored 
faeces, suppression of urine, startings of the tendons, with 
convulsions, cold sweats, a fluttering pulse, and coma super- 
vening on delirium, denote a fatal termination; on the con- 
trary, when there is a copious hemorrhage from the nose, 
mouth, or lungs, or even from the urinary passages or he- 
morrhoidal vessels, or when diarrhoea ensues, when the de- 
lirium is relieved by sleep, and the patient remembers his 
dreams, when the perspiration is free and general, the deaf- 
ness diminished or removed, the pulse less frequent, but 
fuller and soft, and the febrile symptoms become milder, 
there are hopes of a recovery. 

Treatment. — Tanner says : " The principal measures 
usually recommended are strict observance of the antiphlo- 
gistic regimen ; that is to say, general and local bleeding, 
antimonials in some states of the disease, digitalis, active 
purgatives, mercury, blisters to the back of the head and 
neck, and the constant application of cold to the head. 
With regard to venesection, it is advised that the blood be 
allowed to flow until a decided impression is made upon the 
pulse, or until the patient faints. 

" When it is remembered that encephalitis is one of the 
most fatal diseases that can affect the human body, it can 
readily be imagined, from what has been already stated, 
that its dangers are not lessened by such treatment. And 
this seems really to be the case ; for Dr. Abercrombie, in 
speaking of the results of such a course of remedies, says : 
* The cases which thus terminate favorably form, it must be 
confessed, but a small proportion of those which come under 
the view of a physician of considerable practice ; but they 
hold out every encouragement to persevere in the treatment 
of a class of diseases which, after a certain period of their 
progress, we are too apt to consider as hopeless.' With the 



330 



INFLAMMATION. 



greatest respect for this excellent physician's opinions, it 
still seems to me that the extensive failure of one plan of 
treatment should merely lead us to try another ; and more 
especially, perhaps, to see if nature, unaided, or only gently 
guided, will not carry the patient through a disease where 
the efforts of art are notoriously so futile. Be this as it 
may, let us determine not to thwart nature, as we may easily 
do by taking away ' the life of the flesh,' or by poisoning 
it with antimony, and such like agents. Let us rather be 
content to watch the symptoms, to calm excitement by se- 
datives, to lessen increased heat of body by diluents and 
tepid sponging, to prevent accumulations in the intestines by 
purgatives, and to diminish maniacal delirium by the appli- 
cation of cold to the head. 

"Active cathartics of calomel and jalap, followed in three 
or four hours by an aperient draught, are often indispensa- 
ble. They should be repeated every morning, or every 
alternate day. Croton oil is a most valuable purgative in 
some of these cases. Dr. Abercrombie says : 'Although 
blood-letting is never to be neglected in the earlier stages 
of the disease, my own experience is, that more recoveries 
from head affections of the most alarming aspect take place 
under the use of very strong purging than under any other 
mode of treatment.' 

" The application of cold to the head after it has been 
shaved is a remedy of importance. Pounded ice in a blad- 
der, or a cold evaporating lotion, or especially the pouring 
of cold water in a stream upon the vertex of the head, 
will best effect our object. By the latter proceeding, a 
strong man, in the highest state of maniacal delirium, may 
often be subdued in a few minutes. 

"When, from exhaustion of the nervous force, an extreme 
degree of collapse occurs, the only chance of rescuing the 
patient will consist in the administration of stimulants, such 
as ammonia, sulphuric ether, strong beef-tea, wine, etc. In 
all stages of the disease the practitioner must watch his 
patient almost hour by hour, must be careful that he is kept 
dry and clean, and that the bladder does not become dis- 
tended. 



SPECIFIC INFLAMMATIONS. 331 



CHAPTER II. 

SPECIFIC INFLAMMATIONS. 

Under the above head, we will include the various forms 
of tuberculous or scrofulous, cancerous, and syphilitic dis- 
eases, all of which seem to be the result of a species of 
morbid action, which, though not of the precise nature of 
ordinary inflammation, yet is no doubt analogous to it, and 
often gives rise in its progress to true inflammatory action, 
modified, however, by the peculiar condition of the system, 
or of the part which may be affected by the specific action 
of the original disease. We will take the liberty of quoting 
pretty largely from Wood upon this subject ; and, first, of 

tuberculosis, or scrofula. 

In certain cases of the system, a solid extravasated 
matter is deposited in various parts of the body, which, from 
the shape ordinarily assumed by it, is called tubercle. The 
morbid state of system which leads to this deposition may 
be denominated the tuberculous diathesis. It is closely anal- 
ogous to, if not absolutely identical with that which usually 
precedes the development of scrofulous tumors, and which 
is denominated scrofulous or strumous diathesis. In this 
work, they are considered as one affection. When this state 
of system becomes decidedly and obviously morbid, it is 
sometimes called tuberculous, scrofulous, or strumous cachexia. 

The tuberculous deposition takes place in one of two 
forms : either that of small, isolated bodies, or that of ir- 
regular infiltration into the tissues. In either case, the 
matter as first deposited may be gray, semi-transparent, and 
hard, or yellow, opaque, and rather soft. According to 
Laennec and Louis, the deposit is originally of the former 



332 INFLAMMATION. 

character, and afterwards assumes the latter. But the 
matter is often found in both conditions at the earliest period 
at which it can be examined ; and it seems to the author 
that, unless otherwise proved, it must be allowed to have 
been thus deposited. 

When in the form of gray, semi-transparent, hard 
corpuscles, the tubercles have been variously denominated 
miliary tubercles, tuberculous granulations, and gray semi- 
transparent granulations. They do not at first exceed a 
millet seed in size, but gradually increase till they become 
as large as a cherry-stone or larger. A yellow spot soon 
makes its appearance within them, which enlarges by 
degrees until the whole tubercle is converted into a yellow, 
opaque, curdy matter, so soft that it may be crushed 
between the fingers. Sometimes they are in this state 
when first observed. The process of change continues, the 
softness increases, and the tubercle at length breaks down 
into a pus-like matter, with which are often mingled 
portions of the tuberculous substance in a cheesy form. 
This sort of mixed matter may sometimes be found in the 
centre of the tubercle, while the circumference remains still 
hard and unaltered. Not unfrequently, numbers of the 
miliary tubercles are aggregated together, forming a con- 
siderable mass ; in which case, several points of alteration 
may be observed in different parts of it. 

The infiltrated tubercle may be in the shape of large 
irregular masses, as in the lungs ; of flattened patches, as 
upon the serous membranes ; or of sheaths to the blood- 
vessels, as about the veins of the pia mater. — Louis. It 
undergoes the same changes as the isolated tubercles, from 
the gray and semi-transparent, through the yellow, opaque, 
and soft, to the semi-liquid pus-like matter. 

When thus mature, the tubercle excites inflammation, 
and consequent ulceration in the surrounding tissue, by 
which, in many instances, a passage is ,made for the escape 
of its contents. The walls of the resulting cavity, which 
are sometimes lined by a sort of cyst, sometimes consist 
only of the consolidated surrounding tissue, secrete pus, 
which continues to be discharged for a long time, often 



SCROFULA. 333 

mixed with the curdy matter. In man}^ instances, how- 
ever, a healing process at length takes place, the cavity is 
filled, and a cicatrix only remains. This is especially the 
case in scrofulous affections of the lymphatic glands. Some- 
times there is reason to believe that it takes place also in 
the lungs, though in the latter the process of deposition and 
destruction generally goes on more rapidly than that of 
reparation, and the result is fatal. Sometimes, instead of 
the series of changes above described, the tubercle under- 
goes another process, by which the organic matter is 
absorbed, and an earthy or chalk-like substance is deposited 
in its place. This may always be regarded as a favorable 
termination. 

The time occupied in these transformations is very 
uncertain. Sometimes the tubercle remains long quiescent 
in its original form ; and when the change begins, it may 
be completed in a few weeks, or may continue in progress 
for years. Not unfrequently, the disturbance produced by 
the tubercles in the tissue in which they are deposited 
proves fatal before they have passed even their first stage. 
This is more apt to happen when the tubercles are deposited 
in vast numbers, as sometimes in the lungs and the serous 
membranes. 

Tubercles may be formed in almost any portion of the 
body, and often exist in many parts at the same time. 
They are most frequent in the lungs, and, indeed, in adults 
are seldom found in other parts, without existing also in 
greater or less number in that structure. This, however, 
is not a universal rule. In children they are often found 
elsewhere, though wanting in the lungs. After the lungs, 
the parts most frequently affected are, according to Louis, 
first, the lymphatic glands ; then the pleurse, the intestines, 
the spleen, the liver, the peritoneum, the membranes of the 
brain, the brain itself, and the bones ; and lastly, the peri- 
cardium, stomach, kidneys, pancreas, etc. In their various 
positions they produce great disturbance, in the surrounding 
tissue, and give rise to morbid affections, which have 
received different names according to their seat and cha- 
racter. Thus, in the lungs they produce phthisis ; in the 



334 INFLAMMATION. 

pleurse, chronic pleuritis ; in the peritoneum, chronic peri- 
tonitis and abdominal dropsy ; in the mesenteric glands, 
tabes mesenterica ; in the arachnoid, hydrocephalus ; in the 
lymphatic glands, external scrofula ; and in the bones, white 
swellings, caries, necrosis, etc. 

All ages are liable to tuberculous disease, but the two 
extremes Qf life are most exempt. From the researches of 
M. Papavoine, it appears that before the end of the second 
year it very seldom occurs ; from this period to the end of 
the fourth year, is more frequent ; and from four to thirteen, 
is exceedingly frequent. After the age of puberty there is 
some exemption ; but the liability returns towards that of 
maturity, and from eighteen to thirty-five or forty is very 
great. After this it lessens, and the disease is rare in old 
age, at least as an original affection. 

It must be evident, from the foregoing account, that this 
is not a local disease. The tubercles can appear in so 
many different parts at the same time only in consequence 
of some general depravation of the system. In what this 
depravation consists is not evident. It has been thought 
to occur preferably in individuals who present certain 
natural physical traits. Thus, persons have been said to 
be peculiarly predisposed to it who have a clear white or 
rosy complexion ; a soft, delicate skin ; large lustrous blue 
eyes, with long eyelashes, and a pearly sclerotica; thick- 
ness of lips, especially the upper ; a narrow flattened chest, 
with high shoulders ; and, in childhood, a bright, active 
spirit, and precocious intellect. There is no doubt that 
persons with the above characters have often been subjects 
of tuberculous disease ; but too much stress was at one 
time laid upon the complexion, and the color of the hair 
and eyes. Observation has shown that about as large a 
proportion of persons with dark hair, dark eyes, and a 
swarthy complexion are affected, as of those with opposite 
physical characters. Negroes are, in this climate, more 
disposed to the disease than the whites. 

But more confidence may be placed in the signs which 
indicate a commencing development of disease, and which 
often long precede the deposition of tubercle. Such are a 



SCROFULA. 335 

pale, somewhat puffy countenance ; swollen lips, which are 
apt to be sore and chapped in cold weather; tumefaction 
about the nostrils ; occasional purulent discharges from the 
nostrils or ears ; a tendency to soreness of the eyes, and 
especially to a vesicular eruption upon the conjunctiva; 
vesicular eruptions behind the ears, and in different parts 
of the head and face ; sourish or otherwise disagreeable 
exhalations from the skin; slight swelling and induration 
of the glands of the neck, and enlarged tonsils ; a rickety 
condition of the bones ; a weak but excitable pulse ; flabby 
muscles ; a rapid increase in height, without corresponding 
lateral development; and general weakness, indicated by 
fatigue after moderate exertion. It is not to be supposed 
that all these symptoms are present in every case; but 
enough of them frequently are so to justify solicitude, and 
to lead the prudent practitioner to the adoption of preventive 
measures. Not unfrequently, a slight febrile movement, 
rather occasional than persistent, is observed in addition to 
the other phenomena ; and, indeed, such a movement is 
occasionally the immediate forerunner or attendant upon a 
copious tuberculous deposition. 

The tuberculous diathesis is also characterized by the 
modified condition of the inflammatory process which it 
produces. Inflammation, occurring in systems under its 
influence, very generally assumes a slow or chronic form, is 
accompanied with comparatively little heat or pain, and, 
after suppuration, leaves abscesses which heal very slowly, 
and are sometimes exceedingly obstinate. The affection, 
under these circumstances, is distinguished by the name of 
scrofulous inflammation. It is very often the immediate 
result of the tuberculous deposit, acting as a foreign body, 
and irritating the neighboring parts ; and the purulent 
discharge is frequently mixed with broken-down tubercle 
in the form of curdy matter. But the deposition of tubercle 
is not a necessary attendant of all cases of scrofulous 
inflammation. The diathesis appears sometimes of itself to 
predispose to inflammation; and when that process occurs 
from other causes, it assumes the peculiar scrofulous cha- 
racter, even though no tubercles may be present. 
22 



336 INFLAMMATION. 

After the formation of tubercles, and during their matura- 
tion and discharge, the system often sympathizes strongly, 
and there is almost always at first a simple irritative fever, 
and afterwards, when suppuration has become established, 
more or less hectic fever, which, in severe cases, rapidly 
exhausts the remaining strength. 

From the experiments of M. Dubois, of Amiens, it would 
appear that the blood in scrofulous cachexia has a smaller 
proportion of coagulable matter in relation to the serum, 
and that the serum itself is of less specific gravity than in 
health; while the red color of the liquid is in some degree 
independent of the red corpuscles, as if these had under- 
gone a partial disintegration. — Did. de Med., xxviii. 221. 
The blood is therefore watery and impoverished, and inca- 
pable of supplying the nutritive function sufficiently. In 
phthisis, according to Andral and Gavarret, the proportion 
of the red corpuscles diminishes, and that of the fibrin 
increases, with the advance of the disease. That of the red 
corpuscles is almost always below the healthy standard ; 
that of fibrin often above it. But the increase of the 
fibrin is a result of the inflammation occasioned by the 
tubercles ; and we have no proof that it is in excess under 
other circumstances. 

What is the nature of this affection denominated tuber- 
culous disease, but of which the tubercle is a mere incident, 
though a very general, characteristic, and most important 
incident ? This question cannot be fully answered in the 
present state of our knowledge. We know that, generally, 
the vital energies are enfeebled, and the blood impoverished 
or depraved. It is highly probable that the tendency to 
the tuberculous deposition is due directly to the condition 
of the blood. But the state of the blood must itself be 
dependent upon some deficiency or depravation of the func- 
tions by which it is elaborated, and we are thrown back 
upon some original vice in the organic constitution. 

A knowledge of the causes w T hich favor the development 
of the disease may aid us somewhat in understanding its 
nature. These are almost all of a character fitted to lessen 
the energies of the system, and to impoverish the blood. 



SCROFULA. 337 

Insufficient food, confinement, want of fresh air and ex- 
ercise, habitual exposure to cold, sensual excesses, great 
loss of blood or other depletion, and the depressing passions, 
greatly favor the development of tubercles, and even appear 
capable sometimes of generating the diathesis. It has been 
found, by experiment, that tubercles are generated in some 
of the lower animals by close confinement. But there are 
many individuals upon whom all these causes may be made 
to operate, and so intensely even as to produce fatal effects, 
without giving rise to this particular disease. Indeed, it is 
probable that the great majority of mankind might perish 
under these circumstances, and give no sign of tubercles. 
There is something more, therefore, than mere debility. 
There is some inherent peculiarity of the organization, 
generally derived or inherited from the parent, which serves 
as the basis of the disease. The other causes are in general 
merely exciting. They, no doubt, often induce the disease 
when it might otherwise never have been developed ; but 
they are generally incapable of producing it, unless in 
subjects having some innate disposition towards it. In the 
great majority of fatal cases of tuberculous disease, the 
original and essential cause will probably be found to be an 
inherited peculiarity of organization. 

The lymphatic system is evidently the seat of scrofula, 
and the lymphatic vessels are those which carry a light- 
colored or clear fluid. It is generally called the absorbent 
system ; but this, we believe, is not sufficiently full to con- 
vey the whole truth in relation to its functions and uses. 
For the benefit of the reader, a few observations will here 
be made upon this system. It is composed of three orders 
of organs. 

1st. The absorbent vessels, so called, are an assemblage 
of small, delicate, transparent, uneven vessels, provided 
with valves, arising from innumerable roots or fibres, from 
the external and internal surface of the skin, from the 
membranes of the cellular tissue, etc. " These are distri- 
buted among all the organs, like the arterial vessels, of 
which they are the terminations, and terminate mostly in 
the thoracic duct," which empties into the left subclavian 



338 INFLAMMATION. 

vein, and its contents become mingled with the blood ; but 
some communicate directly with the blood-vessels. " Some 
anatomists distinguish the lacteals [the vessels which take 
up the nutrient material from the stomach and bowels] 
from the lymphatic vessels ;" but this is useless in practice. 

2d. " The thoracic duct, in which the major part of the 
lymphatic vessels terminate." 

3d. " The lymphatic or conglobate glands." These are 
small, oval, reddish bodies, composed of white vessels, 
blood-vessels and nerves, distributed here and there along 
the tract of the lymphatics, as the ganglions are " along the 
nerves." They are in greater abundance in the fat of the 
bowels, along the inside of the thighs, in the groin, about 
the neck, in the arm-pits, and generally in all parts of the 
body " where cellular tissue abounds." 

This system has two principal functions — absorption, and 
the preparation and assimilation of the nutritive fluids. 

Under the first head or function "is comprised every 
thing that enters into the current of the circulation, to 
become identified with our structure," excepting those sub- 
stances which, being attracted from the air, mingle at once 
with the blood in our respiratory organs. 

"Absorption is effected," first, on the digestive tubes, 
" on the materials designed to repair the constant waste of 
the body;" second, on the surface of the skin, and on the 
interior of the air-vessels of the lungs ; third, in the interior 
of the cavities of the body. This mode of absorption is 
proved to exist by the mere fact of exhalation. If no 
absorption took place on the surface of the internal cavities, 
we should soon be filled with water. Fourth, in all the 
spaces between the folds of the cellular tissue, and 
" wherever there are any absorbing vessels." 

The second function of the absorbent system is the pre- 
paration and assimilation of the nutritive fluids. In the 
process of forming blood, the lymphatic or absorbent 
system holds an important place. By the powers of this 
system, the homogeneous mass, which is chymified by the 
gastric juice and vital functions of the stomach, loses its 
inanimate character, and begins to become annualized, and 



SCROFULA. 339 

makes approaches to vital matter. It is here the first step 
is taken from the physical to the vital world ; " a species 
of preparation which disposes them to he clothed with the 
properties of the blood which they are destined to renew." 
This may suffice to show how great an influence is exercised 
by the lymphatic system on the material composition of 
the body. We see, therefore, that the formation of blood 
is essentially connected with the absorbent system; it 
follows all its alterations, all its vicissitudes. Thus we 
see that upon the lymphatic system depends, to a certain 
extent, emaciation of the body, as well as the excessive 
development of many of its parts, or redundance of fat, 
serous infiltratives, enlargement of the glands of any and 
every part of the body, the removing of glandular swellings, 
unnatural depositions of fat, etc. These things are, how- 
ever, all performed by a vital process, and not by humoral 
processes or mere percolation. 

The remote causes of scrofulous diseases. These are three. 

First. " Every thing that may effect a diminution of tone 
in the solids," and particularly those of the lymphatic sys- 
tem. 

Second. " Whatever may exalt the irritability of this 
system, or blunt its sensibility;" and, 

Third. "Every thing that occasions chyle or lymph of a 
bad quality," such as unwholesome air, any derangement 
of the offices of nutrition, or the functions of the skin or 
lungs. 

We now come to the predisposing or principal causes of 
scrofula, the first of which may be said to be hereditary ten- 
dency. It is a lamentable fact that a majority of the chil- 
dren that are born of scrofulous parents bring into the 
world with them this tendency, which, when it is heredi- 
tary, is apt to develop itself in early life. These facts are 
doubted by some; but there are too many instances by 
which this truth may be attested. We are acquainted with 
whole families in which the scrofulous taint has been per- 
petuated through two or three generations, says Hufeland. 
In countries where this disease is very common, as in Eng- 
land, the people are so well convinced of this truth, that 



340 INFLAMMATION. 

one of the most important points in the choice of a wife 01 
husband is, that she or he shall be free from the scrofulous 
taint. 

It is a fact in physiology that constitutional diseases are 
hereditary. They are transmitted from parent to offspring, 
as life is transmitted " from one to another." Children are 
often born of scrofulous parents with the disease fully 
formed ; we see this manifested in scrofulous sore eyes ; in 
other cases, in eruptions on the skin, ulcerations, and dis- 
charges from the ears in very early life ; and these are all 
symptoms of scrofula in the bud. Others have enlarge- 
ments of the glands ; and others spina-biflda, or disease of 
the backbone. The cellular tissue is often indurated and 
swollen. These symptoms were first noticed in France, 
and then in England and Germany, as signs of scrofula. 

After all that has been said, it does not follow invariably 
that a child born of scrofulous parents should have scrofula ; 
for " art sometimes contends successfully with nature," and 
the disease may be perfectly eradicated from the system, 
and thereby its train of procreation arrested. 

Of the age and sex most subject to scrofula. All experi- 
ence and observation go to show that children and women 
are particularly disposed to scrofula. This may not aston- 
ish us when we recollect that weakness and nervous sus- 
ceptibility are circumstances most favorable to its develop- 
ment. This subject is of too much importance to keep back 
any thing that will throw light upon it ; and we therefore 
say that nothing is more apt to communicate to children 
the disposition we speak of than weakness of the parents, 
and especially weakness of the organs of generation, "an 
ordinary consequence of onanism and venereal excesses. 
This fate is reserved for the children of those who have 
abused their youthful powers." It is probably not so much 
the venereal virus itself that produces this melancholy effect 
as the abuse of venereal pleasures, and " especially mastur- 
bation." Experience has so fully proved the truths here 
stated, that one must be uncandid to call them in question. 
Is it not reasonable that exhausted parents must communi- 
cate to their offspring a character of debility, of which the 



SCROFULA. 341 

lymphatic system, like other tissues, must partake ? Chil- 
dren of aged and broken-down parents bring into the world 
a disposition of constitution which is easily awakened into 
scrofulous action, and that at an early period of life. The 
temper and constitutional condition of parents at the time 
of conception is that which is communicated to the child, 
and not what they once were. 

There is another fruitful source of scrofula, and that is 
syphilis of parents. We shall, on this point, give an extract 
from Hufeland, which every physician of experience and 
observation will ratify. " It is certain that the scrofulous 
disease is often nothing but the consequences of syphilis. 
I have frequently seen syphilitic parents give birth to chil- 
dren who, either at their birth or very soon afterwards, 
presented all the symptoms of the scrofulous taint ; and it 
has been remarked that since the appearance of the pox, 
this taint has become much more common than it was before. 
At the present day, it is more frequent in those countries 
where syphilis is very prevalent than it is in others. The 
very symptoms, in many cases, have a striking resemblance 
to lues venerea." However close and strong these remarks 
of Dr. Hufeland may be, every physician of experience and 
observation will bear him out in their truth. 

Unwholesome food is another source of the scrofulous 
disease. Any kind of diet that the child's stomach will not 
properly assimilate into chyle, whether it be unwholesome 
for others or not, will, in that child, aid in laying the foun- 
dation of scrofula. Of this kind of diet, we may mention 
improper artificial suckling — the child taking impure or 
badly prepared milk ; for, of all the fluids of the human 
body, none is more endowed with vitality than milk. This 
is proved by the almost instantaneous influence exercised 
by moral affections on the mixture and intimate combinations 
of its constituent principles. " Milk is vital while enclosed 
in its secreting organs ; and the vital principle which ani- 
mates it, while it appropriates it to the infantile constitu- 
tion, renders it, at the same time, more nutritious and more 
digestible." Compare the children that are nourished at 
the maternal breast with those that are artificially brought 



342 INFLAMMATION. 

up, and we shall find generally that while the former are 
fresh-looking and healthy, the latter remain weak and 
languid, at least for the first one or two years of their 
existence. See how the consumptive invalid, who is ready 
to die with debility, bears a diet of milk sucked directly 
from the teat of the animal, or drunk while still foaming 
with its natural heat. But let the same milk become cool, 
and lose the heat of vitality which it brought from the 
animal that afforded it, and it will become indigestible, and 
sicken the invalid who drinks it. Whence arises this differ- 
ence, if it does not depend on the principle of life with 
which the milk is animated while enclosed in the organs 
that prepare it, and which vanishes as soon as it ceases to 
be in contact with them ? Sucking, then, is the order of 
nature, by which she supplies the infant with a portion of 
life from the mother, till its system becomes so perfected 
that it can vitalize its own food. Children, therefore, that 
are raised by hand, or artificially fed, are more liable to 
scrofulous affections than those that are properly nursed by 
the mother. 

We are apt to forget that animals which furnish us with 
milk feed entirely on vegetation, or are herbivorous, while 
women derive their nourishment from each of the three 
kingdoms of nature. There is, therefore, a difference in the 
milk of animals and of women ; and this difference is pro- 
duced by the different aliments on which they live? There 
is in the milk of animals something of a vegetable nature 
that does not exist in the milk of women. Hence the fre- 
quent acidity of the stomachs of children that are raised by 
hand. The child, by the motion of its lips in sucking, 
occasions a flow of saliva into its mouth, which mixes with 
the milk and enters into combination with it, thus causing 
it to be more easily digested. 

It is a fact that delicate stomachs bear solid better than 
liquid food, the only reason of which is, that solids are 
mixed with the saliva before they are swallowed, while 
liquids enter the stomach just as they are taken into the 
mouth. " It is difficult to portray all the difficulties that 
arise from artificial suckling." The milk is sometimes too 



scrofula. 343 

hot, sometimes too cold, sometimes too old, and sometimes 
spoiled. 

Again : the milk of different animals differs very much, 
that of no two, perhaps, being exactly alike ; and therefore 
a mixture renders the milk less healthy than it would be if 
it were all taken from one cow. 

It is a little surprising, yet true, that ass's milk ap- 
proaches nearer to that of women than the milk of any other 
animal. 

All farinaceous substances that have not been fermented 
or well boiled are difficult of digestion. The chyle they 
furnish is pasty and of a weak consistency ; it circulates 
slowly in the lacteal vessels and clogs them up. Such is 
the effect of potatoes when they constitute the principal 
diet of children ; and it is remarkable that scrofula is very 
common "where children are nourished on this root." Vege- 
tables that are very watery, and consequently contain but 
little nourishment, promote scrofula. 

The habit of feeding children on a little of every kind 
of food, and thereby weakening the powers of digestion, 
and making bad chyle, promotes the scrofulous disposi- 
tion. 

Another fruitful source of scrofula is impure air. " This 
is one of the most frequent and powerful causes of the dis- 
ease in question." Cold, damp air is most favorable to its 
development. This is the reason why scrofulous affections 
are almost endemical in low places, "particularly with a 
northern aspect." " They are more common in the north 
than in the south ;" are rarely seen under the tropics ; but 
are frequently met with on the shores of the sea, " and par- 
ticularly in England, among children that live in low, damp 
places." 

Goitre, which is a local affection, is endemical in moun- 
tainous countries. 

Cretinism, a general affection, which we regard as the 
highest degree of the scrofulous diathesis, and which is en- 
demical in the deep valleys of the Tyrol, and the Pays de 
Vand, is visibly the effect of cold, humidity, privation of 
solar light, a highly carbonated atmosphere, and perhaps, 



344 



INFLAMMATION. 



also, of a peculiar modification of the atmosphere, which 
chemistry has not yet been able to detect. 

An inconstant and variable air is another fruitful source 
of scrofula ; and this is the reason why it is more common 
in high, mountainous countries than in those more level, or 
slightly undulating. 

An air highly charged with animal vapors or carburetted 
hydrogen gas is very productive of scrofula. Hence, large 
manufactories and crowded cities are less wholesome and 
produce more scrofulous cases than the country. The 
higher the houses and the narrower the streets, the more 
unhealthy will be the city, and the more cases of scrofula 
will be found in it. " It is not possible to conceive of the 
whole influence of bad air in producing the strumous habit." 

This influence is naturally enough explained, on the sup- 
position of the suspended functions of the skin, the filthi- 
ness which follows the debility which results from it, and 
the absorption of the deleterious principles of the atmo- 
spheric air. u Every thing that will iveaken the digestive powers 
will promote scrofula ;" such as acidity of the stomach, in- 
testinal worms, the abuse of opium and other narcotics in 
childhood, want of exercise, want of cleanliness, abuse of 
heat or cold, precocious studies, too early exercise of the 
sexual organs, onanism, and great depression of spirits, etc., 
all of which, by weakening the powers of digestion, aid in 
causing an imperfect chyle to be formed, and thereby assist 
in laying the foundation for a scrofulous disposition in the 
constitution. 

It is also excited into action by diseases of irritation; and 
hence we often see scrofula follow small-pox, measles, or 
scarlet fever. These diseases, if badly treated, as well as 
many other diseases, will often develop scrofula when it 
would otherwise have lain dormant. And here, perhaps, the 
physician or nurse should bear the blame. 

We now come to treat of the external appearances of 
scrofula ; and, in doing so, we shall avail ourselves of the 
ample experience and clear elucidations of the physician to 
the King of Prussia, than whom no one has been more 
satisfactory on this subject. 



SCROFULA. 345 

Of the external appearance of scrofula. There is a habit 
and an external appearance connected with the scrofulous 
diathesis that is almost inseparable from it. Where this 
appearance of the body is presented, no doubt as to the 
scrofulous taint can exist. The principal features of it are, 

1. A short, thick neck. 

2. Jaws rather broader and stronger than common. 

3. The head rather large in proportion to the other parts 
of the body, especially the back part of the head. 

4. Light-colored hair. 

5. The face slightly bloated; its skin delicate, transpa- 
rent, white, and somewhat rosy. 

6. Most commonly the eyes are blue and the pupils large. 
This appearance often indicates a scrofulous state of the 
mesentery. 

7. The upper lip very thick. This is one among the 
symptoms which do not mislead. It is, however, sometimes 
periodical. 

8. The nose is often a little swelled, red and shining. 

9. The whole body appears to be fat and well nourished; 
but, on a close examination, the flesh is found to be flabby 
and soft. It does not possess the resistance and elasticity 
which indicate health and vigor. 

10. The belly is somewhat larger than it ought to be, 
although it may not have become as hard as it will be in the 
future progress of the affection. Sometimes it becomes very 
large from the slightest cause. The following developments 
of the organs are irregular ; as, 

11. The development of the teeth, bones, and muscles. 
Learning to walk and talk, also, are either difficult, back- 
ward, or very irregular. 

12. The intellectual faculties and organs of generation are 
prematurely developed. Such children are apt to become 
addicted to masturbation, and should be attended to on that 
subject. Girls in whom these symptoms exist require more 
attention from their mothers than those who are not of a 
scrofulous habit. 

It is not an uncommon thing for a teacher or parent to be 
struck with an unusual manifestation of intellect in such 



346 INFLAMMATION. 

children ; but in a few years they arrive at their acme, and 
all efforts to push them further are vain. 

The scrofulous taint shows itself even in the develop- 
ment of puberty. "Retarded and irregular menstruation 
often depends on no other cause." 

Persons laboring under the scrofulous taint are apt io 
bleed at the nose frequently, and have frequent colds or 
coughs, with a wheezing respiration. " Small spontaneous 
ulcerations, peculiar to children, situated on the inside of 
the legs and thighs, and under the armpits, which do not 
yield to the ordinary measures of cleanliness, and small 
pimples of various forms and sizes, and scabby," are signs 
of scrofula. The body may enlarge in some parts more 
than others, and appear to be swelled, " but does not pit on 
pressure." This swelling is seen on the arms, legs, face, 
and scrotum, and this symptom should be particularly 
noted by the mother. Pains in the kisides of the legs and 
thighs, subject to periodical returns, sometimes accompanied 
with more or less swelling for a few days, and a white dis- 
charge from the vagina of infants, are further signs. 

There is also, in scrofulous habits, a manifest disposition 
to a sour stomach. The stools are variable ; sometimes too 
solid, sometimes too liquid, and rarely of the right color 
and consistency. 

The appetite is irregular, with a particular fondness for 
dry bread; mucous disorders of the bowels, flatulency, 
distension of the belly, wind in the bowels, spasms and 
colics, etc., also accompany the disease. These constitute 
a large majority, at least, of the second stage of symptoms 
of scrofula. 

We have, however, besides the above symptoms, at dif- 
ferent times, a peculiar form of fever, which, by some, has 
been called mesenteric fever, gastric fever, inward fever. 
These different forms of fever show nothing more nor less 
than that there is a scrofulous disposition in the system, 
though it may not yet be developed ; and this peculiar form 
of fever, in its different variations, might more properly be 
called scrofulous fever. It generally appears in children 
under two years old, is very irregular, and its course and 



SCROFULA. 347 

type are indefinite. It is various as to its duration, some- 
times passing off in a few days, and, in other cases, con- 
tinuing for several weeks, but in a mild form. The tem- 
perature of the body is not high, but the skin is sometimes 
manifestly too cold. There is sometimes attending it a 
slight cough, with wheezing. The belly is always a little 
swelled ; and to these symptoms succeed glandular swell- 
ings, eruptions on the skin, scabs on the head, and emacia- 
tion of the body. 

This form seems to be the line of transit from a scrofulous 
taint or disposition to the development of scrofula. 

We have now brought it to that point where it falls, in 
some degree, under the inspection of our senses. "Not 
only are the vital forces changed, but the organization of 
the glandular system is altered ; its functions are disturbed, 
and the disease manifests itself plainly by the swelling of 
the lymphatic glands." At first, they are small and mov- 
able under the fingers ; they feel elastic, and there is no 
discoloration of the skin. 

The glands that first manifest this development of the 
disease are situated in the sides of the neck, under the 
lower jaw, and under the ears ; and a particular examina- 
tion of these glands will give the proper character of their 
affection. As above stated, they are at first small, loose, 
separate, and uninflamed ; but, after a while — for their 
progress to suppuration is very slow — they gradually en- 
large, and the swelling is communicated from one to another. 
The cellular tissue and sacs containing the glands thicken, 
and the tumor enlarges, till finally it becomes hard and im- 
movable. The glands under the veins and in the groins 
swell in their turn; and, in some instances, those of the 
whole body swell. 

It is uncommon for a single gland to be affected in 
scrofula. The virus will extend from gland to gland, in 
the same region, till several are affected by it ; and they 
are often so connected together as to make an enormous 
tumor. At length the disease, in passing from gland to 
gland, affects the lymphatic vessels, which become thick 



348 INFLAMMATION. 

and hard, and feel like hard cords passing from one gland to 
another. 

These tumors are variable; they sometimes rise and 
diminish alternately for a long time, while in other cases 
they enlarge, and remain so for years, before they sup- 
purate. "In proportion as the scrofulous taint increases, 
the tumors become hard and immovable ;" yet they may 
feel cold and indolent; but, sooner or later, the gland in- 
flames, and suppuration takes place slowly. When the pus 
is discharged, it is of an unhealthy character, mixed with 
curds, and, in some instances, with thin, hard, white flakes, 
or concretions, not unlike small pieces of an egg-shell. 
"In other cases, the swelling passes into a schirrous and 
even an osseous state." 

In some cases, the lymphatic glands acquire an enormous 
size ; they have been seen to weigh " ten pounds and 
more." We suppose, in these cases, that the tumor had 
changed its scrofulous character, for that of a steotomatous 
tumor, though the scrofulous blemish or hue may still re- 
main upon them. 

In some cases, the whole body is covered with scrofula ; 
that is, tumors and sores appear on every part of the body. 

The external surface is not the only part affected by 
scrofula ; the fat and glands of the bowels become the seat 
of the disease also. The fat of the bowels, stomach, and 
chest, in these cases, is studded with tumors, from the size 
of a small pea to that of a walnut. This, we can readily 
see, obstructs the due process of chylification and mesen- 
teric functional nutrition, and the patient becomes ex- 
tremely emaciated, and dies from starvation. This is what 
is called, by writers on the diseases of children, tabes 
mesentericus ; which is nothing more nor less than scrofula. 

The heart, brain, and liver, in their turn, become affected 
with this disease ; but, in adults, the most common of all 
its determinations is the lungs. Here it shows itself in the 
form of tubercular consumption ; which, though it may be 
warded off for years, will ultimately prove fatal. 

Scrofulous children rarely have a clean head. They are 






SCROFULA. 349 

liable to have small pustules and oozing sores on the back 
of the neck, which emit an unpleasant smell. Sometimes 
these sores terminate in real scald-head. These children 
are apt to have sore eyes, which are difficult to cure. The 
glands of the eyelids pour out a viscous humor, denomi- 
nated by Scarpa "palpebral flux." The eyelids, in the 
morning, are glued together, and are separated with diffi- 
culty. The sight is frequently weakened, and, in some 
cases, the cornea, or black part of the eye, becomes diseased 
and turns white ; in which case, vision is destroyed. 

Such children frequently have styes on their eyelids, and 
their ears are apt to discharge an ichorous, thin, fetid 
humor. 

In consequence of the disease of the mesenteric glands, 
the belly enlarges and becomes hard, while the legs and 
arms fall away, till the skin may be wrapped around them 
like a piece of cloth. The skin shrivels, looks dead, and 
feels harsh. 

All scrofulous ulcers are not preceded by swelling of the 
glands, for some of them seem to be developed spontane- 
ously, in consequence of a lesion of the lymphatic system. 
These sores present a foul appearance, the matter formed in 
them never being of the healthy kind ; it is clear, watery, 
and very irritating. They heal in one place, and break out 
in another ; they are not very painful, but are obstinate to 
heal, and tend to perpetuate themselves almost without end. 

To conclude these remarks, we will simply say, that 
scrofula terminates in disorganization, sooner or later, if 
not cured before it arrives at that point. The manifesta- 
tions, then, of disorganization are : First, a wasting away 
of the whole body and limbs, from mesenteric disease. 
Second, white swellings in the joints. Third, spontaneous 
dislocation of the joints. Fourth, suppurations of the 
glands in different parts of the body. Fifth, ulcerations on 
the surface, and about the eyes, head, and ears. Sixth, 
scrofulous dropsies. Seventh, tubercular consumption, and 
enlargements of the bones, caries, and spina-bifida. Eighth, 
scrofulous cancer. Ninth, tabes abdominalis, or abdominal 
consumption. Tenth, rickets. Eleventh, a peculiar affec- 



350 INFLAMMATION. 

tion of the nervous system, such as spasms, cramps, paraly- 
sis, or palsy, supervening upon and caused by the retro 
cession of scrofulous matter from one part to another. 
Twelfth, cretinism, which, perhaps, is the highest grade of 
the strumous constitution. In this case, the whole body or 
system is scrofulous. 

We might write a volume on scrofula, but here we must 
conclude ; the importance of the subject being our only 
apology for the length of this description of the disease — 
a disease than which there is no other so full of importance 
to the human family. The fond father, the loving mother, 
the tender, innocent infant, who has had no part in bringing 
itself into the world, and into this state of suffering; the 
general and individual prosperity, happiness, and peace of 
society — all call aloud upon parents to examine this subject 
closely, understand it well, and assiduously avoid the 
causes which produce it. — Bright. 

Diagnosis. — Scrofulous inflammation of the glands is dis- 
tinguished from ordinary chronic inflammation of the same 
parts by the greater hardness of the tumors, their less 
degree of tenderness upon pressure, their longer continuance 
and greater indisposition to yield to treatment, their 
frequent complication with other scrofulous affections, and 
by the state of system which precedes or attends them. 
The practitioner will also be influenced in forming his judg- 
ment by the hereditary or family influences, which may 
have served to create a peculiar predisposition in the 
patient. 

Treatment. — The point which should be first aimed at is 
the correction of the peculiar state of system in which the 
tubercular deposit, and the other characteristic morbid phe- 
nomena of scrofula, originate. While this condition remains, 
our efforts to correct the local disease will at best be useless, 
and may be very injurious. Either the tumors will resist 
our remedies, or, if they yield and disappear, the diathesis 
will exhibit itself in disease of some other and more 
dangerous part. It is no uncommon event for the recession 
of scrofulous swellings upon the neck, or in other external 
situation, to be followed by pulmonary consumption. 



SCROFULA. 351 

Instances of this kind have come under the notice of the 
author. The late Dr. Parrish, of Philadelphia, whose 
experience in this form of disease was ample, had so much 
dread of such translations, that he always employed mea- 
sures calculated immediately to discuss scrofulous tumors 
with great caution, and generally preferred leaving them 
entirely alone, addressing his remedies solely to the system. 
That the swollen glands are sometimes relieved exclusively 
by local means, and with impunity, only proves that in 
mild cases the morbid tendency may exhaust itself by the 
first demonstration, and cannot be admitted as a justifica- 
tion for a similar course in cases where the tendency may 
be much stronger and more permanent. 

In order to correct the state of system, it is of the 
utmost importance to remove the causes which may have 
produced and may still be sustaining it. The patient 
should be surrounded with circumstances most favorable to 
the production of sound health without undue excitement. 
The vital forces should be invigorated, and the vital actions 
moderately supported; but care should be taken not to 
stimulate the latter beyond the healthy standard. A fresh, 
pure air at all times, and exercise within the limits of 
fatigue, are among the most efficient remedial measures. 
If the patient be compelled to labor for a livelihood, he 
should, if possible, select an avocation in which the muscles 
generally might be called into action, and which would not 
require confinement to close, and especially to crowded 
apartments. Among the worst situations for a scrofulous 
patient are the crowded wards of an ill-conducted and over- 
peopled hospital. The diet should in general be simple, 
digestible, and nutritious, but not stimulating. Farinaceous 
substances, the more easily digested fruits and vegetables, 
milk, meats in moderation, and especially boiled meats, may 
be employed. Should the patient find himself over-stimu- 
lated by animal food, he should diminish the quantity, or 
abandon it for a time. But in relation to diet, reference 
must be had to the stage of the disease and the state of 
the system. 
23 



352 INFLAMMATION. 

It is therefore always safest to commence with general 
treatment, and let the local disease alone, at least for awhile. 

The best alterative which I have ever used, in the course 
of a long experience, in scrofula, is the following : Fluid 
extract of sarsaparilla, six ounces; tincture of valerian, 
two ounces ; syrup of rhubarb, two ounces ; oil of sassafras, 
one drachm; piperin, thirty grains; iodide of potassium, 
six drachms ; mix. Dose, a teaspoonful three times a day, 
for a child, to be taken in milk ; a tablespoonful may be 
taken by an adult. After the above quantity has been 
taken, the medicine should be suspended for a week or two, 
and the following given instead : Wild-cherry bark, elecam- 
pane, and burdock root, each, one ounce ; good spirits, one 
quart; let it stand forty-eight hours, then strain, and add 
one pound of coarse-grained cane sugar, and heat until it 
dissolves. Dose, a tablespoonful for a child two or three 
years old, and in proportion for older persons ; it is best to 
give it, and all other medicines intended to enter the circu- 
lation, after eating. The medicine then combines with the 
food, and is absorbed with it ; whereas, if given on an empty 
stomach, it is often refused by the absorbents, and passes 
off with the dejections, and no benefit is derived. The 
principal object of changing the medicines is, that the sys- 
tem may not become insensible to their action by long 
repetition. These means, with the occasional use of others 
for meeting particular conditions, as laxatives in constipa- 
tion, prepared chalk and nutmeg, for too much looseness 
of the bowels, etc., have, in my hands, superseded the 
necessity of resorting to any other internal remedies for 
removing the constitutional disease ; and, this being done, 
its local manifestations will be easily managed, and often will 
disappear without the use of any external means. When 
there is much deficiency of the red globules of the blood, 
shown by the want of color on the surface, and a tendency 
to bloat, indicating dropsical effusion, iron, in some form, is 
recommended by every author, and its use should never be 
neglected. The best form which I have found for giving it 
is the following : Take of elecampane root, four ounces ; 
water, one quart; simmer for two hours, strain, and then 



SCROFULA. 353 

simmer it down to about half a pint; add one pound of 
coarse brown sugar while the infusion is hot; after it has 
cooled, add one ounce of burnt copperas, [sulphate of iron,] 
well pulverized and sifted ; mix thoroughly, and shake the 
bottle well before using, each time. Dose, a teaspoonful 
after each meal. 

Now, why the above form should act better than many 
other preparations of iron, I am not able to give a very 
satisfactory reason ; but that it does, much experience has 
proven to my full satisfaction. I will relate a case illustra- 
tive of its power over this cachectic condition : A son of 
Mr. T. Mason, of Smith county, of rapid growth and flabby 
texture, had exposed himself, along with other boys, by 
wading in the creek, catching minnows ; a severe cold ensued, 
attended with enlargement of the glands of the throat and 
neck, followed by general bloating of the whole body; sur- 
face unusually white and apparently semi-transparent, much 
resembling a frozen turnip ; breathing hurried by the least 
exertion ; general muscular weakness, and great indisposition 
to move; pulse rapid; and, though the artery felt large 
under the finger, yet the slightest pressure was sufficient to 
arrest the current of the blood. I drew . a few ounces of 
blood from the arm, in order to ascertain whether the pecu- 
liar whiteness of the surface was really owing to deficiency 
of the red corpuscles, or to the effusion of serum in the 
cellular tissue under the skin, or to both. I found the 
blood almost colorless ; it merely left a slight dirty-looking 
stain upon white linen. I prescribed the above formula in 
tablespoonful doses three times a day, and nothing else, 
except bathing in hot mustard water, and dry friction to 
the surface ; and requested that I should be informed if no 
material amendment was experienced in a few days. I 
heard of him no more, until about three weeks after, when 
I was sent for to see another member of the family. While 
there, a fine rosy-cheeked boy came into the room, and 
seemed unusually glad to see me ; his father observed that 
I didn't seem to recognize my patient, and I had not, nor 
could I, after being informed that it was the same child 
whom I had before seen, with hardly vitality sufficient in 



354 INFLAMMATION. 

the blood to continue the very lowest manifestations of life 
There was now evidently an excess of red corpuscles in the 
blood, and, on examination, I found his pulse not only full, 
but also rather resisting, indicating active plethora ; and 
fearing that this condition, if continued, might lead to the 
development of some form of active inflammation, I ordered 
the medicine to be discontinued and his diet restricted ; no 
return of scrofulous or cachectic symptoms were afterwards 
seen. 

I will now give a very different case. The patient was 
a youth of about eighteen, but would have been taken for 
ten or twelve. So deficient had been the development of the 
physical system, that signs of puberty were wholly wanting. 
His weight was but sixty pounds ; and much the larger half 
of this was owing to a hard and tumefied abdomen. His 
skin was shrivelled, and of the color of pipe-clay ; in short, 
he presented all the symptoms characteristic of a sample 
case of cachexy and dirt-eating. He came of scrofulous pa- 
rents ; and, out of many brothers and sisters, all, except one 
beside himself, had died of some form of the disease before 
puberty. 

Notwithstanding this patient was so emaciated, and had so 
■little vitality, yet there was a constant tendency to fever, 
alternating with sweats or diarrhoea. I prescribed the 
before-mentioned formula, as in the other case ; and, to break 
up the fever, prevent the wasting discharges from the sur- 
face and bowels, and also arouse the liver, which was en- 
larged and torpid, I gave a pill every night made as follows : 
blue-mass, sul. quinine, and castile soap, each twenty grains ; 
make twelve pills. 

The pills were discontinued after the twelve had been 
taken ; but the chalybeate and the tonic syrups were con- 
tinued alternately for several months ; a gradual improA r e- 
ment was soon perceptible, and in twelve months the change 
was truly remarkable : from a puny-looking child, he had 
changed to quite a respectable-looking young man ; puberty 
had not only taken place, but the new, rich blood had occa- 
sioned feelings which prompted him to " take to himself a 
wife." 



scrofula. 355 

As I left that neighborhood soon after the occurrence of 
this important. event in his history, I am unable to follow 
his fortunes farther ; but it would be interesting to learn, in 
the event that he became the father of children, whether 
they inherited the constitution of their parent as a scrofu- 
lous boy or as a vigorous man. I would judge the latter ; 
"for thou shalt beget a son in thine own image and likeness :" 
such as thou now art, and not such as thou hast been, or may 
yet be in the future. 

Local Treatment. — Although scrofula is a constitutional 
disease, and must be met by remedies addressed to the gen- 
eral system, which will remove the scrofulous condition out 
of which or from which the local manifestations proceed, jet 
much may often be done by means applied directly to the 
local disease. By these measures, if timely resorted to, the 
external disease may be kept in check, and time gained for 
removing the constitutional condition, which it is often very 
important to gain, as much suffering and annoyance may 
thereby be warded off, and, when seated about the neck, or 
other parts usually exposed, deformities prevented, which is 
no trifling consideration in the case of girls ; unsightly scars 
about the throat and neck are little less dreaded than death 
by them ; and this feeling, to a certain extent, is not only 
natural, but right. God made the beautiful as well as the 
useful in nature ; and in man, and especially woman, he 
exhibited the finest specimen of his "handiwork," and it 
becomes our duty, as far as possible, to prevent this inimi- 
table work of God from being marred, and its beauty turned 
into deformity. But, besides this, the local affection reacts 
upon the general condition, -and makes it more difficult of 
removal ; and, in case of large suppurating surfaces, this is 
often impossible to be done, owing to the exhaustion which 
they occasion by the heavy draught which is made upon the 
materials of nutrition; and the nervous disturbance and 
want of rest which they occasion, often greatly interfere 
with ihe general health ; so that local treatment is, in many 
cases, not only a valuable assistance, but an indispensable 
necessity to the successful management of the case. 

These remedies may be properly divided into two classes : 



356 INFLAMMATION. 

the first includes those which have a tendency to bring about 
resolution, and so prevent suppuration and the formation of 
an abscess. The second embraces all those means which 
may be rendered effectual in hastening the reparative pro- 
cess by which lost tissues may be restored, and an abscess 
healed, if already formed. While upon the subject of gen- 
eral treatment, it was unnecessary to specify particular forms 
or manifestations of the scrofulous disease or condition; but 
now this becomes essential, as the treatment will have to be 
varied according to the nature of the tissue principally 
involved and the locality of the local disease. And, first, of 
that form known as king's evil, involving the glands of the 
neck and throat. Fortunately, these enlargements are usually 
very slowly developed, giving ample opportunity for the 
exhibition of constitutional remedies, as well as for the 
application of local appliances ; but no time should be lost 
in bringing every means to bear upon the disease as soon as 
it is known to exist ; for when the scrofulous predisposition 
or diathesis has once been awaked by an exciting cause, and 
the peculiar inflammatory action characterizing active scrofula 
set up, the longer it continues, the more intense the scrofu- 
lous condition becomes, the greater will be the amount of 
tissue especially involved, and the further will be the pro- 
gress of structural change, and, of course, the greater will 
be the difficulty of restoring the natural condition again, 
both general and local. Those having the care of children, 
therefore, who have inherited a scrofulous taint, or who have 
shown any predisposition to that disease, should timely 
institute such a course of management as will be most likely 
to ward off the development of* the disease, or to check it, 
as it were, in the bud. 

Pretty full directions have already been given as to the 
best general management and treatment, which the reader 
would do well to become perfectly familiar with; and if 
there have been some things said which are hard to under- 
stand, and unfamiliar terms used, which I know are very 
annoying to most readers, yet recollect that the subject 
required them, and could not have been treated sensibly 
without their use ; and a few re-perusals will not only enable 



SCROFULA. 357 

you to comprehend the principles, but will render these hard 
terms "as familiar as household words." "Words are the 
signs of ideas/' and you will hardly receive many new ideas 
without also having to learn new words. Doctors, and 
writers on medical subjects, are often upbraided with unne- 
cessarily using words unfamiliar and often harsh to the 
ears of the unprofessional, but they do so of necessity; the 
idea intended to be conveyed must have a representative, 
and often none can be found in the common vocabulary, and 
circumlocution, or going round about to get at the matter, is 
unpleasant in conversation, and often becomes of necessity 
low and unpardonably vulgar in a writer, and, after all, 
generally fails to convey the clear and precise meaning 
which can be done by a single word fitly chosen. The 
author has not, therefore, tried to bring down the subject of 
the science of medicine to the level of the entirely unlearned, 
but he has endeavored to meet them half-way, and has, as 
far as possible, used the same term to represent the same 
idea, so as to lessen, as much as can be done, the labor of 
learning new words ; and he thinks that the careful reader 
who has followed him thus far will find himself little annoyed 
hereafter with new terms, except the mere names of dis- 
eases; and, as he has almost necessarily become familiar 
with most that have been used, he will move pleasantly 
through the balance of the pages of this work. But to re- 
turn from this digression. 

We were saying that while the general course calculated 
to remove the scrofulous condition was steadily persevered 
in, measures should be taken to cause the absorbents to re- 
move the morbid deposits composing the tumors. Many au- 
thors protest against the use of such means, believing that 
the constitutional disorder would be augmented by throwing 
into the system the materials of which these enlargements 
are composed, and that it is best to solicit suppuration in 
them, so that the tuberculous matter might, in this way, find 
an outlet. 

But as long as the scrofulous condition remains, the ma- 
terial of which tubercles are formed will be still manufac- 
tured; and, as we have seen its production is always enr 



358 INFLAMMATION. 



o 



couraged by the mischief of the local disease, it appears to 
be reasonable that endeavors should be made to cut off this 
aid to its production ; and the result of such efforts have, in 
our hands, proved entirely satisfactory, and fully convinced 
us that the above is the true philosophy upon the subject. 

Therefore, when called to see a patient whose general ap- 
pearance and history indicate a scrofulous constitution, and 
we find, besides the symptoms arising from the general stru- 
mous condition, enlargements of the glands of the neck, or 
the outcropping of the disease in any other form, we at once 
put him upon the general treatment before recommended, and 
also make vigorous endeavors to suppress the local manifes- 
tations ; and as all these manifestations are the result of in- 
flammatory action, modified, it is true, by the general condi- 
tion, and therefore properly classed as specific, yet still it is 
inflammation, and composed of the same elements with 
other inflammations, and may be successfully treated by the 
same means. Such means will then be proper which tend to 
bring about the first and most favorable termination of in- 
flammation, viz., by resolution; and these are such, as my 
readers have been informed, as will excite capillary action 
in the part, and thus relieve the congestion, and, at the same 
time, excite the absorbents to take up the morbid deposits, 
and thus remove or rectify the structural change. A liberal 
application of the chloroform liniment will often meet all 
these indications, but I generally prefer to aid its action by 
other means, so as to increase the certainty of success ; there- 
fore, after bathing the tumefied parts for 15 or 20 minutes 
with the liniment, I paint it well with tincture of iodine, 
and, when this is dry, cover all the enlargement with collodion. 
In treating of the general management of inflammation, we 
spoke of the advantage derived from equable pressure, ob- 
tained by the roller bandage ; but this could not be applied 
to the neck or groin, or other parts often the seat of scrofu- 
lous enlargements, but I have found all its advantages could 
be obtained by the use of collodion ; the contraction which 
takes place on drying, occasions very considerable pressure, 
and that more equably than can ever be done with the band- 
age, and by this means the enlarged vessels are compressed 



SCROFULA. 359 

so as to force their contents onward, and supported so as to 
enable them to regain their tone, and the absorbents stimu- 
lated to take up the morbid deposits; for these vessels are so 
endowed, that pressure is the natural stimulus which calls 
them into increased action; by this means foreign substances, 
or dead parts, are either eaten up by the absorbents, or the 
sui rounding tissues cut away, and the offending body loosened, 
and a way prepared by which it may escape, or be extracted. 
A perfectly sound limb may be made to diminish under the 
pressure of the bandage, and new products are always more 
readily acted on by the absorbents than the permanent tis- 
sues, which enables us to cause morbid deposits to disappear, 
and still leave the natural parts entire. 

My readers will now perceive that stimulation, to excite the 
vital activity of the capillaries, and pressure, to promote ab- 
sorption, are the means which would be naturally suggested 
by a knowledge of what is wanted to be done, in order to re- 
mote these scrofulous enlargements without the tediousness 
and" inconvenience of suppuration and ulceration, and without 
entailing a blemish upon the patient. But if the disease has 
proceeded so far that a termination by resolution cannot be 
brought about, then the next best end that can be obtained 
is active suppuration. The lye poultice will usually assist 
maturation as much as any application that can be resorted 
to ; and as soon as there is any evidence of softening in the 
centre of the tumor, it should at once be opened by making 
a free incision with a sharp lancet. The operator will per- 
haps think he has opened it prematurely, for, in this stage, 
nothing will probably escape but serum stained with blood ; 
but if the part is now dressed with some stimulating poultice, 
pus will soon appear. These risings should be opened as 
soon as possible, for two reasons ; one is, that if you wait for 
it to become ripe, like the common phlegmon or boil, it will 
consume much time, as these risings are often extreme]y slow 
in maturing ; and, secondly, as the amount of fibrin, which 
chiefly forms the plastic lymph, by which lost parts are re- 
paired, is always deficient in the scrofulous condition, if the 
skin is suffered to become broken by ulceration, or become 



360 INFLAMMATION. 

very thin, considerable loss of its substance will be sustained 
before the reparative process can be set up, and an ugly scai 
will inevitably follow. 

But if the disease be timely attended to, the means recom- 
mended will rarely, if ever, fail to produce resolution. But 
their daily application must be persevered in until the tumor 
has very sensibly diminished; then the surface may be covered 
by court-plaster ; which will tend to continue the necessary 
support to prevent a return of the swelling. 

If, after the rising has been lanced, and poulticed until the 
centre, or core, has become detached and removed, the ulcer 
should not be disposed to heal, it must be stimulated ; and 
nothing has been found to answer this purpose so well as the 
chloroform liniment. But used in full strength, it generally 
proves too intensely stimulating, causing more suffering than 
is necessary, and should therefore be modified by the addi- 
tion of some bland material ; an equal quantity of liniment 
and mucilage may at first be used, and as the sensibility # be- 
comes blunted, less mucilage may be added, until finally the 
liniment itself may be borne in full strength. But as it is 
essential that an impression should be made, some smarting 
is unavoidable ; but it only lasts for a minute or two, and 
then leaves the part more comfortable than it was before the 
application. As soon as the ulcer appears to be in good con- 
dition the liniment should be discontinued, as its protracted 
use will finally render the part insensible to its influence. 
The ulcer may then be dressed with pledgets of lint satu- 
rated in cold water or whisky. I prefer the latter, as it 
serves to keep up a gentle stimulation, and thus maintains 
the healthy tone gotten up in the vessels by the use of the 
liniment, and prevents a necessity of resorting to that remedy 
again. Nothing in the shape of grease should be suffered to 
come near the ulcer ; hence all salves and ointments are to 
be avoided. This seems very strange to most persons, who 
have seen such applications relied on in the treatment of 
every kind of sore or ulcer. 

I was once attending an Irishman for a chronic ulcer on 
the leg. After several days he inquired if I was not going 



SCROFULA. 361 

to use some kind of Hutment. I told him no, I should use 
nothing that had grease in it. " Well," he replied, " I never 
knew a sore cured without using an Hntment or plasther." 

We have said that a deficiency of plastic material in the 
blood renders wounds difficult to heal in persons of a 
strumous habit ; hence the frequency and inveteracy of sore 
legs in such habits ; and nothing but a rigid and long- 
continued course of the means calculated to remove the 
scrofulous condition, and give tone to and increase the vital 
energies of the system, will succeed in their management. 
But the above local measure may at the same time be used, 
so as to cause the improvement of the local disease to go on 
or even outrun the restoration of the general health. In 
some instances, the wasting discharge from a large scrofu- 
lous ulcer is so profuse, and its irritability so great, as to 
react upon the constitution so injuriously, that no general 
treatment will be availing without first getting up some 
improvement in the local disease. But how can this be 
done? As the plastic materials of the blood are defi- 
cient, the reparative process cannot take place until these 
constituents are increased ; and as their elaboration requires 
the very highest effort of the vital powers, how is it 
possible to obtain more fibrin, out of which to manufacture 
new material to supply the lost parts, and without which 
an ulcer will not heal, without first obtaining an improve- 
ment of the general health ? These inquiries seem natural, 
and a few years ago I would have said it could not be 
done ; but I now know that it can. The difficulty originates 
in a mistaken view of the manner in which fibrin is pro- 
duced, and where plastic lymph is elaborated. I shall not 
stop here to explain the process by which fibrin is made, 
but I will assert that plastic lymph is manufactured by the 
capillaries, and that they may be forced to produce it when 
there is hardly a vestige of fibrin to be detected in the 
blood ; and hence the inference is, that it too is manufac- 
tured by them at the time when, and in the place where, it 
is wanted. By way of proving that u these things are so," 
and at the same time illustrating my method of treatment 
of chronic ulcers, I will detail a very interesting case in 



362 INFLAMMATION. 

point, which was treated in the State Hospital a few years 
ago. A young man by the name of Stalkup, of decided 
scrofulous predisposition, but who had never suffered from 
any of its open forms, received a kick from a mule on the 
outer side of the leg, a few inches above the ankle; the 
injured flesh sloughed out, and left an ill-conditioned ulcer, 
which all the domestic remedies that could be devised by 
his friends failed to heal; finally, a great part of the leg 
became involved, and his general health failed, so that it 
was thought advisable to send him to the hospital for treat- 
ment. But all efforts to arrest the disease proved abortive, 
until it was thought that amputation of the limb presented 
the only chance for saving his life. Professor Eve, who 
had the case in charge, called a consultation of the phy- 
sicians who happened to be present, to witness a capital 
operation. All expressed the opinion that death in a very 
short time would inevitably take place unless the leg were 
removed, and were also nearly as unanimous in believing 
that the vital powers would give way under the operation. 
I suggested that if the immense drain from the ulcerated 
member couid be restrained, so as to allow the system to 
recuperate a little under tonic treatment, it would increase 
the chances of the operation proving successful. Dr. Eve 
admitted this, but said the remedies usually resorted to in 
such cases had all been unavailingly tried, and inquired if 
I knew of any that would probably succeed. I replied 
that I believed so, and suggested the remedies, and my 
reasons for thinking they would prove successful. Dr. Eve 
then asked me if I would take charge of the case for a time 
sufficient to test the value of my suggestions, which I did. 
No change was made in the general treatment, for that, I 
thought, was about as good as any I could devise; local 
applications were alone depended on for altering the con- 
dition of the ulcer and checking the immoderate drain. 
The condition of the limb at this time was as follows : 
at least two-thirds of the leg, from the knee to the 
ankle, presented a loose, flabby ulcer ; most of the soft 
parts had sloughed away, leaving the bone in places ex- 
posed; the discharge was prodigious, and was exceedingly 



SCROFULA. 363 

foetid ; the body greatly emaciated; countenance haggard; 
colliquative sweats, etc. A physician present remarked 
that he did not appear to have a particle of fibrin in his 
composition; of course this was not meant to be taken as 
strictly true, and yet it was evidently not far from the 
truth. I had chloroform administered so as to partly deaden 
his sensibility — for, notwithstanding the great want of 
capillary action, there was morbid sensibility — and then 
thoroughly washed the ulcer with the chloroform liniment, 
made less pungent by using three times the ordinary 
quantity of spirits of nitre, also adding a grain of sul. of 
morphia to the ounce; the leg was then lightly done up 
with the roller bandage, the lost parts being supplied by 
lint saturated with whiskey, which was also ordered to be 
occasionally poured upon the dressings. The first dressing 
had the effect of completely destroying the foetor, and in 
forty-eight hours the discharge was lessened to a fourth of 
the usual quantity ; the edges of the ulcer, from being pale 
and flabby, had become hard and slightly red, and in place 
of the bottom being covered with the results of broken- 
down tissue, there was evidently a secretion or exudation 
of plastic lymph. This favorable condition continued ; and 
in the course of a week the improvement was so great that 
nothing further was said about an amputation. New mate- 
rial was rapidly formed for filling up and repairing the lost 
parts, and the condition of the whole system greatly 
improved ; appetite and digestion became good ; flesh again 
separated the skin from the bones ; in short, general 
restoration took place, and that under the same general 
treatment under which he was before sinking. Now the 
main points in this case are, that it proved that fibrin is 
manufactured by the capillaries ; and that, by proper stimu- 
lation, they can be made to furnish it at the particular part 
where it is wanted, and to make it, too, out of exceedingly 
poor blood. 

This case went on improving until he became stout and 
able to take active exercise ; the usefulness of the limb was 
restored so that he could walk very well with the aid of 
a stick to supply the deficiency occasioned by some of the 



364 INFLAMMATION. 

muscles being wholly lost ; the limb became of natural size, 
but there was so large a surface to be covered with skin, 
that the process was protracted, and Mr. Stalkup got tired 
of waiting, and left the hospital to engage in some business ; 
since which time I have lost sight of him. 

The same general and local remedies are equally appli- 
cable and efficacious in that form of scrofula called white 
swelling. This disease, if taken at a very early stage, can 
be aborted ; but if the inflammation is suffered to run on 
until it terminates in suppuration, the cure is slow and 
difficult; for as the pus is generally confined between the 
bone and its investing membrane, the periosteum, and as 
this membrane is dense and fibrous, and not easily cut 
through by the absorbents, much time often intervenes 
before the matter can find an exit. This confinement is the 
cause of much of the suffeiing usually endured in this 
disease. Now the reader must understand that the bones 
receive nearly all their blood, and are nourished by minute 
vessels extending into them from the periosteum; conse- 
quently, when this membrane becomes detached by a collec- 
tion of matter under it, that part of the bone which received 
its nourishment from it necessarily dies, and finally ex- 
foliates — that is, the absorbent vessels belonging to the 
sound part of the bone cut the dead part loose, and it then 
becomes movable, and often finds its way to the sur- 
face. 

But this process is always carried on very slowly, and 
often takes years for its accomplishment; and though the 
violence of the suffering abates after the periosteum gives 
way under the ulcerative process, and the matter finds an 
outlet through the other tissues to the surface, and an 
opening is made by nature, or artificially, through the 
integuments for its discharge, yet the constant irritation 
which is kept up by the dead bone acting upon the sur- 
rounding tissues, prevents them from healing, and occasions 
an abundant .secretion of pus, which, being usually of a bad 
quality, acts as a further source of irritation, and is a great 
annoyance to the patient by its filthiness and disagreeable 
odor. By these means the constitutional disorder is increased, 



scrofula. 365 

the blood impoverished, hectic fever set up, and the energies 
of the system exhausted, so that death often kindly puts an 
end to a life of suffering. But if the scrofulous depravation 
of the blood is not very great, and the patient be surrounded 
with circumstances of comfort, and such as are calculated 
to improve the energies of the system, the subject will often 
bear up under all these afflictions ; may even grow and 
mature as other children ; and when the dead bone finally 
becomes detached and discharged, the abscess may heal and 
no mischief remain, further than a shortening of the limb 
from retarded growth. Few cases, however, result so favor- 
ably ; most commonly, even while the process of reparation 
may be slowly going on in the original seat of the disease, 
it extends to new portions of the limb, and -other pieces of 
bone die and exfoliate ; so that, while bony deposits may 
be made to supply the loss of one portion of the bone, the 
destructive process is going on below, or above, until in 
this way, in the course of years, almost the whole bone 
may be destroyed and escape, a piece at a time, and still 
something answering the place of a bone remain, though 
unshapely and unsightly. 

Nothing more need be said with regard to general treat- 
ment in white swelling; it must be the same as in other 
forms of scrofula, except that it may be necessary to be 
longer continued ; neither does the local disease require 
peculiar treatment, except with respect to the removal of 
the dead bone, which should always be accomplished as 
soon as it possibly can be done, for as long as this remains, 
no efforts can cause the ulcer to heal. The great difficulty 
is to get the dead part detached from the living; for bone 
having but few blood-vessels or absorbents entering into its 
composition, all the processes, whether of destruction or 
reparation, are very slowly carried on. But much, very 
much can be done by art to hasten the exfoliation or sepa- 
ration of the dead bone. By means of powerful stim- 
ulation as much can often be accomplished in a very few 
weeks as would otherwise require as many years. No 
stimulus with which I am acquainted possesses any thing 
like the same power of quickening the action of the vessels 



366 INFLAMMATION. 

concerned in the process of exfoliation as the chloroform 
liniment. 

Three distinct objects must be kept in view in the man- 
agement of these cases : first, to remove the general scrofu- 
lous condition, which has been sufficiently dwelt on; 
secondly, to bring up the action of the local parts to the 
healthy standard, so that they may be able to throw off the 
parts already dead, or too much diseased to be capable of 
restoration ; and, thirdly, to remove these detached bones ; 
and I think I can better illustrate my manner of fulfilling 
all these indications, so that the reader can fully understand 
it, by detailing cases, than can be done by preceptive teach- 
ing ; and will, therefore, ask indulgence, should I be a little 
tedious in giving the history of a very interesting case 
which was successfully managed a few years since, and 
which will fully illustrate my method of meeting each of 
the above indications. This case is selected because of its 
suitableness, and because the gentleman who was the sub- 
ject of treatment is pretty extensively known, and sug- 
gested that his case should be published for the advantage 
of others. J. W. Tolson, now a commission merchant of 
Mobile, Alabama, was attacked with white-swelling of the 
right thigh when about nine years old, which pursued the 
usual course described above ; after continuing without any 
permanent amendment for about six years, it made its ap- 
pearance also on the opposite arm, above the elbow ; three 
years after this he came to Nashville and consulted the 
author, at the suggestion of his brother, Dr. L. S. Tolson, 
of Richmond, Miss. 

Mr. Tolson presented the appearance and temperament 
thought to be peculiarly indicative of tuberculous tendency, 
viz., fair and clear complexion; large lustrous eyes; light 
sandy hair ; sprightly and vivacious, but subject to spells 
of low spirits and great despondency; intellectual above 
the common order ; ardent, and rather enthusiastic in his 
pursuits of either business or pleasure, etc., etc. His per- 
son was pretty well developed, and he would have been of 
over medium height, had not his stature been lessened 
by an arrest of the growth of the diseased leg, and a push- 



SCROFULA. 367 

ing up, as it were, of the pelvic bones of the sound side, 
occasioned by their having to sustain the whole weight of 
the body, at a time, too, when they were in a growing con- 
dition, and also preternaturally yielding in consequence of 
a lack of bony material common to young persons of 
the strumous diathesis. His general health was moderately 
good, and he ate and digested sufficient aliment to have 
sustained a full habit ; but so much of the nutriment was 
expended by the enormous discharges which daily took 
place from the diseased limbs, that he remained lean, and 
had the general appearance of one who lacks nourishment. 
On examination, I found several fistulous openings in his 
leg, scattered along two-thirds of the space between the 
knee and the head of the femur or thigh-bone, each of 
which could be traced by the probe to dead bone ; and, as 
some of these openings were found on each side of the 
thigh, it appeared as though the greater part of the bone 
was devoid of life, which ultimately proved to be the case. 
As Mi Tolson was naturally rather fastidiously nice in his 
feeling, he took great pains to avoid any show of the dis- 
charge upon his garments ; and, besides a plentiful supply 
of lint and raw cotton, enveloped the limb with several 
yards of common domestic ; yet all these would frequently 
become thoroughly saturated in a few hours, and had to be 
regularly renewed four or five times in the day. In his 
arm there were found three fistulous openings, two of which 
were a little below the head of the bone, and nearly oppo- 
site to each . other, and the third within the lower half, 
nearest the elbow, showing that the greater part of this 
bone also, both in its length and substance, was dead, at 
least that the external surface was. The discharge' from the 
arm was also immense, for besides saturating as much cot- 
ton and domestic as could conveniently be applied, several 
times in the day, a half pint, at least, would be each time 
emptied from a kind of pocket or sinus, which had been 
formed in the arm-pit or axilla. 

Now although no dead bone had ever been discharged 
from the arm, as the probe could be made to grate upon its 
rough surface, it was known to exist ; and, as nothing more 
24 



368 



INFLAMMATION. 



than small scales had been thrown off from the carious 
femur or thigh-hone, it was evident that the process of 
exfoliation was progressing exceedingly slow, if it was 
taking place at all. In the general treatment of this case, 
I depended exclusively upon the prescriptions already 
given, or what amounts to substantially the same thing, 
viz. : compound syrup valerian, [fever syrup,] and com- 
pound syrup sarsaparilla, each, eight ounces ; iodide of 
potassa, one ounce. Dose, a dessert-spoonful after each 
meal. The chloroform liniment was exclusively depended 
on for correcting the fcetor, lessening the discharge, and 
hastening the separation of dead bone. It was freely 
injected into the sinuses three times a day ; at first diluted 
with three times its bulk of water, but afterwards gradu- 
ally used stronger. The general proceeding was, to first 
throw into the ulcers, by means of a half-pint syringe, as 
much castile soapsuds as was sufficient to cleanse them 
thoroughly, then throw into the sinuses as much of the 
stimulant as would fill them; over the fistulous openings, 
large pledgets of cotton, saturated with whiskey, contain- 
ing an ounce of liniment to the pint, and over these the 
roller bandage, applied moderately tight, the whole to be 
kept saturated with the whiskey and liniment. The dis- 
charge was soon materially lessened, and considerable ex- 
citement gotten up in the diseased limbs, so that poultices 
of slippery-elm had occasionally to be applied at night, and 
a sufficient amount of epsom salts taken daily to keep down 
general febrile excitement, and also serve as a means of 
abstracting the surplus amount of fluids from the blood 
which had usually been discharged from the ulcers, and 
thus prevent any plethora or other damage from arising 
from so sudden a stoppage of such a considerable drain. 
The salts were sometimes taken in full purgative doses, but 
generally in small quantities in a large quantity of water, 
so as to imitate the water of saline springs, and. like that, 
operate by promoting an increased secretion from the kid- 
neys ; then, for a time, its use would be wholly suspended, 
just as evidence of fulness, or symptoms of weakness, 
indicated. By these means this immense drain, which had 



SCROFULA. 369 

continued for nine years, was gradually dried up without 
occasioning any of those untoward events which are usually 
enumerated as apt to follow the stoppage of a drain of long 
continuance. But the credit of this favorable result is not 
wholly, or indeed chiefly, due to the use of the salts ; the alter- 
ative syrup did much more, by changing the morbid condi- 
tion of the system, and promoting a vigorous exercise of 
the vital powers ; in consequence of which, the material 
which was formerly thrown off in a crude state by the 
secreting surfaces of the ulcers, was now changed into a 
proper form for healthy nutrition. 

In the course of a few weeks the beneficial effect of the 
stimulating injections became very apparent, as small parti- 
cles and occasionally scales of bony matter were washed 
out by the soapsuds injections ; finally, a large mass was 
ascertained, by examinations with the probe, to have be- 
come at least partially detached, and I thought it advisable 
to prepare a means of outlet ; and not being fond of using 
the knife, I resorted to the dilating properties of slippery- 
elm ; at first using a bougie made of this material for the 
purpose, just large enough to enter the fistulous opening 
which appeared to be nearest to the upper end of the loose 
bone, and by replacing this daily with one a little larger, 
in the course of ten or fifteen clays the opening was suffi- 
ciently capacious to admit of a thorough examination. A 
very large piece of detached bone was ascertained to exist, 
and efforts were made to extract it by bringing its end to 
the opening, and twisting and pulling with strong forceps ; 
but it would not come, and I requested Professor Eve to 
operate, by making a sufficient incision, which he kindly 
did, and found that a piece comprising more than one half 
of the entire thickness of the femur, and nearly half its 
length, had become detached, except at the end where it 
joined the condyle or large protuberance of the knee-joint; 
here no attempt at a separation of the dead from the living 
bone seemed to have been made, but they appeared to in- 
sensibly run into each other, so that it was impossible to 
determine where death reigned, or where life began. The 
connection was finally severed close to the joint; the sur- 



370 INFLAMMATION. 

face, however, showed that some unsound bone was still 
left ; but it was thought best not to proceed any farther, 
for fear of injuring the joint. 

As we availed ourselves of the advantages of chloroform, 
the operation occasioned very little sensible suffering; and 
as the loss of blood was trifling, no injury resulted from 
the operation, but a very great good was obtained, a large 
foreign body was removed, and the irritation occasioned by 
it got clear of. Water dressings were now used to keep 
down inflammation, and the sinuses injected, as before, with 
the liniment and whiskey. In a very short time the 
sinuses all closed by a healthy growth of granulations, or 
their sides adhered by a deposition of plastic lymph, and that 
only remained open which led to the condyle of the knee, 
at which point, we have said, there was some diseased bone 
left remaining. But pretty soon granules of bony matter 
appeared in the discharge, and the surface became evidently 
smoother, and presently blood flowed from it by the slight 
rubbing occasioned by an examination with the probe, 
giving satisfactory evidence that granulations had formed 
upon the surface, and that a cure was near at hand. 

The treatment proved still more successful in the disease 
of the arm ; for, soon after commencing the use of the stimu- 
lating injections, bone, in a state of disintegration, appeared 
in the discharge, or was washed out by the soapsuds injec- 
tions ; showing that a softening of the dead bony structure 
was taking place, and giving hopes that the whole might 
thus be got rid of, without our friend suffering the pain of 
an operation for its removal; and these hopes were not 
illusory, for after a few weeks the probe decided that granu- 
lations were forming upon the parts which had been divested 
of their periosteum, deciding that a cure was in progress. 
It thus proved, as was at first hoped, that only the outer 
surface of the arm-bone was altogether dead, and the lini- 
ment brought up the languishing action in the deeper parts 
to the healthy standard, and at the same time caused the 
dead pellicle to disintegrate, or become resolved into parti- 
cles, so that it could be forced out by the washings. 

As soon as this bony matter ceased to appear, and the 



SCROFULA. 371 

parts that could be reached by the probe were found to be 
well covered with granulations, a compress was laid over 
the course of the sinuses, and the roller bandage applied 
sufficiently tight to bring the sides of the cavities together, 
so that they might become joined by means of the plastic 
lymph which was now abundant in the discharges. Adhe- 
sions were soon formed, and all evidence of disease removed 
from the limb. 

In about four months from the commencement of treat- 
ment, Mr. Tolson left for his father's home, near Choctaw 
Station, Miss., in fine health, and as clear of any evidence 
of the terrible disease under which he had labored for nine 
long years as he was before he was afflicted, except the 
shortening of the limb referred to, and a very small sore 
near the knee-joint, which soon after disappeared. 

During the progress of the disease, Mr. Tolson, having 
obtained a situation in the Baptist Publishing House tem- 
porarily, did full service as clerk and book-keeper most of 
the time, and thus prevented time from dragging heavily, 
and more than cleared his expenses, including doctor's fees. 

It is now over three years since the cure was effected, 
and I learn that it still proves to be radical. A few weeks 
since, the author had a communication from him, in which 
he says : " My old disease has now been well over three 
years. It has, during that time, made a few slight attempts 
at returning, but has subsided of itself, or been removed by 
the efforts of nature." 

The points of interest in this case to a physician would 
be, that it shows, contrary to currently received opinion, that 
the process of exfoliation may be artificially hastened, and 
that in a remarkable degree — making weeks stand for years, 
and even more than that — and that thin portions of dead 
bone may be made to disintegrate, and come away in 
granules with the other discharges. To the masses it is 
interesting by showing that this formidable disease can be 
cured — a matter that is doubted by many ; and it is pecu- 
liarly interesting to the nurse, as it serves admirably to point 
out the manner in which such cases can be successfully man- 



9 



72 INFLAMMATION. 



aged. Many similar cases could be given, but it is not 
thought necessary to task the reader any further. 

An inquiry might naturally arise here, whether, after a 
scrofulous disease has been thoroughly cured, and the 
scrofulous condition fully removed, as in the above case, 
a taint will still remain in the system which can be com- 
municated to posterity. Our opinion is, that no greater 
probability exists of the offspring of such person inheriting 
the predisposition to tubercular or strumous diseases than 
of those born of members of the same family in whom the 
disease had never been manifested, or even less probability, 
for the constitutional remedies appear in many instances not 
only to remove the scrofulous condition, but also the predis- 
position, so that no strumous taint is left ; and, as has before 
been said, " like begets like," and it is not the likeness 
of what the parent once was that is communicated, but that 
which obtains at the present. Hence, the first children of 
scrofulous or tuberculous parents rarely inherit the predis- 
position ; but those that are born after the disease has been 
fully developed, often have the disease in actual form at 
birth. 

PHTHISIS CONSUMPTION. 

Tubercular phthisis, or pulmonary consumption, is a con- 
stitutional disease, manifesting itself chiefly by certain 
changes in the lungs. 

Pathology. — The origin and formation of tubercle has 
already been considered in the section on Tuberculosis. It 
is only necessary to mention, therefore, that in phthisis the 
tubercular deposit takes place in the areolar tissue between 
the air-cells, in the air-cells themselves, and in the smaller 
bronchial tubes communicating with them, and that wherever 
a speck of this matter is deposited from the blood, it con- 
tinues to increase by constant addition. In its hard state, 
it is called crude tubercle. After a time, inflammation arises 
in the pulmonary substance surrounding the deposit, suppu- 
ration occurs, the tubercular matter softens and breaks 
down, and at length is gradually expelled through the bron- 



CONSUMPTION. 373 

ehi, trachea, and mouth, leaving cavities or excavations 
behind of various sizes. Sometimes these cavities close and 
heal; more frequently tubercular matter continues to be 
deposited on their sides, and in other parts of the lungs, 
until these organs become diseased to an extent incompatible 
with the continuance of life. 

Symptoms. — The general symptoms of phthisis are cough, 
haemoptysis, debility, expectoration, dyspepsia in some form 
or other, acceleration of the pulse, slight dyspnoea, loss of 
flesh, hoarseness, sweating, and diarrhoea. A mark at the 
reflected edge of the gums, usually deeper in color than the 
adjoining surface, and producing a festooned appearance by 
the accuracy with which it corresponds to the curve of the 
gingival border, has been observed to be very frequently present 
in these cases. Sometimes, especially in males, fistula in 
ano is one of the earliest symptoms. The disease ordinarily 
sets in with a short, dry cough, which the patient often refers 
to the trachea. It is doubtless due to tubercular deposit 
irritating the bronchial membrane ; it may continue some 
time without being aggravated, or without the supervention 
of any other symptom. Occasionally there is haemoptysis, 
which, recurring at variable intervals, gives the first intima- 
tion of the disease. The hemorrhage may be so considerable 
as to kill directly or indirectly. The patient complains also 
of languor; slight exertion, ascending a hill, or going up 
stairs, causes fatigue, hurries the breathing, and often gives 
rise to palpitation ; the uterine functions are more or less 
disturbed in women, and the liver becomes congested and 
tender. When this state has lasted for some time, during 
which the cough and expectoration have been increasing, 
hectic fever appears. The debility becomes more marked ; 
the countenance becomes frequently flushed ; chilliness is 
complained of in the evening, while on awaking in the morn- 
ing the body is found bathed in a profuse sweat, and there 
is loss of appetite, with thirst, etc. The patient now rapidly 
loses flesh ; diarrhoea — either due to disordered secretions, 
or to ulcerations of the mucous membrane of the ileum and 
colon — often sets in, and increases the debility ; the urine is 
found sometimes to contain albumen, an^ occasionally minute 



374 INFLAMMATION. 

quantities of sugar; the lower extremities frequently become 
painful and oedematous, and death soon ends the scene, the 
mental faculties remaining clear until the last few hours. 

Diagnosis. — Some authors have divided phthisis into three 
stages. During the first, that in which tubercles become 
developed in the lungs, neither the local nor the general 
symptoms warrant us in announcing the presence of any 
other affection than severe catarrh ; if the tubercles be de- 
posited, however, in considerable quantity, the sound on 
percussion will be dull, the act of expiration will be pro- 
longed, from impairment of the elasticity of the lungs, and 
bronchial respiration and bronchophony will be heard; the 
vesicular murmur will be feeble or even absent. In the 
second stage, the tubercles increase both in number and size, 
so as to compress and obstruct the substance of the lung, 
and occasion dyspnoea ; large crepitation will be distinct, and 
in the sound lung puerile breathing. In the third stage, the 
tubercles become softened ; they make an opening for them- 
selves through some of the surrounding or involved bronchi, 
and being thus evacuated, they give rise to the formation of 
cavities. Auscultation now elicits a peculiar sound, called 
gurgling, caused by the bubbling of air with the pus or 
mucus contained in the cavity. Gurgling, it must be re- 
membered, may also arise from that rare disease, circum- 
scribed abscess of the lung, as well as from the mixture of 
air with liquid in a dilated bronchus affected with chronic 
inflammation. When the cavity contains no liquid, we 
hear cavernous respiration ; if it be large, amphoric resonance 
and pectoriloquy will also be distinguishable. Notwith- 
standing the existence of one large or of numerous small 
cavities, percussion almost invariably affords a dull sound, 
owing to the layer of lung forming the wall of the cavity 
being dense and solid. 

Causes, etc. — Phthisis may be inherited or it may be ac- 
quired ; it is not contagious. Of 1000 cases, collected by 
Dr. Cotton, at the Consumption Hospital, 367 were heredi- 
tarily predisposed ; 582 were males, and 418 females. The 
left lung suffers more frequently than the right; in Dr. 
Cotton's cases, the left lung was affected in 455, the right 



CONSUMPTION. 375 

in 384, and both in 161. The apices and posterior parts of 
the upper lobes of the lungs are ordinarily the situations in 
which the deposit first takes place. 

No period of life is exempt from this scourge ; according 
to the Registrar-General, half of the deaths that happen on 
an average in London, between the ages of twenty and forty, 
are from consumption and diseases of the respiratory organs. 
About one in five die of consumption in our Northern States; 
in the South, not quite so many. Insufficient and bad food, 
impure air, the dirty dust suspended in the air which the 
people of cities have to breathe, confinement, deficiency of 
light, and immoderate indulgence of the sensual passions, 
may be regarded as frequent causes. Its ordinary duration 
varies from about six to twenty-four months ; it very rarely 
proves fatal in less than three months, unless indirectly 
from severe pneumonia or pleurisy. 

Treatment. — This resolves itself into that necessary for 
the prevention of phthisis, and that to be adopted to stay 
its course when it has once developed itself. As regards 
prevention, I need only refer to the observations on Scro- 
fula, as the remarks there made apply with equal force to 
the disease under consideration. 

When the disease is present, when tubercles have become 
developed in the lungs, we must endeavor to improve the 
general nutrition, by attention to the quantity and quality 
of the food, by pure mild air, by warm clothing, and by the 
administration of cod-liver oil. As regards the diet, only 
the most nutritious food should be allowed ; an animal diet 
is absolutely necessary, so long as the powers of the stomach 
and alimentary canal are sufficiently strong to digest and 
assimilate it. When the powers of the digestive organs 
fail, pepsine, in doses of gr. xv., with the two principal daily 
meals, should be ordered. Milk is also very nutritious, and 
so are raw eggs. Strong broths, a small allowance of wine, 
or of good bitter ale, may often be advantageously permitted. 
Too long an interval should not elapse between each meal. 

Change of air and scene is an important element in the 
treatment ; though it must be remembered that this change 
is to be resorted to only jn the early stages ; for it is cruel 



376 INFLAMMATION. 

to send patients away merely for them to die. When soft- 
ening of the tubercles has begun, it will be too late to ex- 
pect much benefit. 

Cod-liver oil, particularly the brown variety, is a most 
valuable remedy : it nourishes the body ; diminishes the 
cough, expectoration, and night-sweats ; and, there is every 
reason to believe, checks the fresh exudation of tubercular 
matter. In the beginning, a teaspoonful should be given 
twice or thrice daily, and gradually increased to a table- 
spoonful three times a day. Where the stomach will not 
tolerate this agent, enemata containing it may be tried ; or 
it may be introduced into the system by inunction, or rub- 
bing it on the surface, and by applying lint saturated with 
it to the chest. 

The various preparations of iron are very useful in many 
cases ; especially during the first stage of the disease, pro- 
vided there be neither haemoptysis nor pulmonary conges- 
tion. Iodine and its compounds, especially the iodide of 
potassium, have been highly praised ; the iodide of iron is 
the best preparation. Liquor potassce is often useful in the 
early periods, particularly when combined with bark. When 
the cough is severe, small doses of opium or morphia, fre- 
quently repeated, give relief; when there is troublesome 
haemoptysis, the oil of turpentine, five drops every hour, 
often checks it, or the acetate of lead may be tried ; when 
the heart's action is irritable, it may be controlled by hy- 
drocyanic acid, with or without small doses of digitalis ; if 
the night-sweats weaken and annoy the patient, they may 
often be checked by gallic acid, or by the mineral acids with 
bark, or especially by the oxide of zinc in four-grain doses 
at bedtime ; while the diarrhoea, when urgent, must be 
stopped by catechu, logwood, or opiate injections. Counter- 
irritation to the chest by sinapisms, turpentine stupes, and 
particularly by the tincture, often gives relief. Pyro-acetic 
spirit or naphtha has been highly but undeservedly praised, 
since it more frequently does harm than good ; and the 
same observation applies to arsenic, oxalic acid, phosphate 
of lime, oxygen gas, blisters, dry-cupping, daily emetics, and 
a host of similar and dissimilar remedies. — Tanner. 



consumption. 377 

The results of my own practice in true pulmonary con- 
sumption have not been very satisfactory. I have, how- 
ever, had good reason to believe that, taken in the early 
stage, the treatment which I have recommeDded in scrofula, 
together with constant pustulation of the chest with emetic 
tartar or croton oil, has frequently arrested the develop- 
ment of the disease ; and in later stages, the same treat- 
ment, with the addition of an opiate at night to insure 
undisturbed rest, has done much toward warding off the 
fata) result, and rendering life more comfortable while it 
lasts. 

But though little can be done in the present state of 
knowledge towards a cure, much may be accomplished by 
way of prevention. We will, therefore, give the reader the 
benefit of the best we know upon this important subject. 
Pulmonary consumption, or rather a predisposition to it, all 
authority agrees is frequently inherited from one or both 
parents, and it looks reasonable that it should be ; for as 
we perceive children to resemble their parents in the 
features of their face, and in the disposition of their minds, 
so there can be no doubt that . they also resemble them in 
the internal organization of the body, on the peculiar struc- 
ture of which a predisposition to future disease must 
necessarily depend ; and that children are in fact liable to 
the diseases of their parents, Ave have manifold and decisive 
proofs. How frequently do we see a person, at a certain 
time of life, so much resemble what a father was at the 
same period, that he seems to fill the identical place in 
society that the former occupied ! In like manner, at 
certain periods of life, do children become liable to the 
diseases of their parents, and consumption, gout, or dropsy 
makes its appearance, the germs of which must have lain 
in the system from the earliest period of existence, although 
they did not disclose themselves till their due season. Not 
only do we see that children are peculiarly prone to the 
diseases of that parent to whom they bear the greatest 
personal similarity, but as we occasionally perceive the 
resemblance of some more remote ancestor break forth, as 
it were, in a family, so we shall find the constitution and 



378 INFLAMMATION. 

diseases of that child differ from those of its immediate 
parents, and partake rather of the nature of the progenitoi 
whom it most resembles. 

These circumstances are thus particularly noted, because 
it is only in cases where the predisposition to this disease is 
suspected at a very early period of life, that the means of 
prevention can be employed with any reasonable prospect 
of success. For the same reason, also, I am desirous of 
attracting the attention to a point of similarity between 
parents and children which has not hitherto been sufficiently 
attended to. The form and structure of the nails of both 
extremities afford an excellent criterion to enable us to 
judge which of the parents the offspring most resembles in 
constitution. I have known the peculiar structure of a 
toe-nail designate certain individuals of a family for several 
successive generations. Although these parts of the human 
body do not make their appearance earlier than about the 
sixth month of the foetal age, they indicate very decidedly 
the predominant influence of the parent whom the child 
most resembles in constitution. It is also a curious fact 
that the horns of animals, which often do not appear till 
several months after birth, afford the best criterion for dis- 
tinguishing the peculiar breed or race, to those who are con- 
versant with such subjects. 

But certain peculiarities in the structure of the nails 
afford also a strong indication of the propensity to phthisis. 
In forming an opinion concerning the probable future occur- 
rence of this disease, the nails ought always to be carefully 
examined and compared with those of the parents. If 
these parts of the body are large, of an oblong shape, of a 
smooth texture, and a pink color, curling over the tips of 
the fingers, the last joint of which is commonly somewhat 
enlarged, there is much reason to suspect a phthisical 
tendency. If, moreover, we find a slender conformation 
of the body, fine skin and hair, a shrill voice easily rendered 
hoarse, hollowness of the temples, sound teeth, and an 
expanded pupil of the eye, there is little doubt that a 
person so constituted will, at some future period of life, 
become the victim of pulmonary consumption. 



consumption. 379 

The aggregate of these appearances constitute what is 
termed delicacy of constitution. This habit of body is 
frequently accompanied by superior powers of mind. Indi- 
viduals, indeed, who seem almost to approach the perfection 
of our species, are peculiarly marked as the victims of 
pulmonary consumptions. This fact not only furnishes a 
strong motive for endeavoring to prevent the first attack of 
affections of the lungs, but affords also some grounds to 
encourage the expectation of success. Soundness of teeth, 
a marked concomitant of the phthisical habit, is commonly 
considered as one of the surest signs of a sound constitu- 
tion. A variety of examples might also be adduced of 
persons who, after having subdued, by regimen and medi- 
cine, phthisical symptoms with which they were threatened 
in their youth, have protracted existence to a very advanced 
period of life. As the propensity to this disease must 
necessarily be the result of a certain combination of habits, 
continued perhaps from one generation to another, combined 
with the peculiar circumstances in which the individual is 
placed, it is reasonable to suppose that, by altering the 
former, and counteracting the latter, the general constitu- 
tion might be changed. 

Pulmonary consumption is a disease almost peculiar to a 
certain zone of northern latitude, in which our Northern 
States are included. A little farther to the north, or to the 
south, the ravages of these complaints are comparatively 
trifling. The only natural cause to which this can with 
propriety be attributed, is the fluctuation of our atmo- 
spheric temperature between the confines of heat and cold. 
The increased frequency of pulmonic complaints, which has 
accompanied the more general diffusion of wealth, and 
consequent habits of luxurious living, in this country, 
affords, I think, sufficient proof that tender and indulgent 
treatment is not the best means of obviating them. What 
are the classes of mankind most susceptible of, and most 
injured by, the impressions of heat and cold ? Precisely 
those who are least exposed to their influence. Sedentary 
artificers, who necessarily pass their days in close and 
heated chambers, are swept off in unaccountable numbers 



380 



INFLAMMATION. 



by pulmonary consumption; while sailors, ploughmen, 
butchers, and all persons whose occupations lead them to 
be much in the open air, enjoy a comparative immunity 
from the attack of this disease. Among the aborigines or 
native inhabitants of this country, Doctor Hush informs us 
that pulmonary consumption is unknown ; but in proportion 
as they adopt the arts and manners of civilized life, do they 
become liable to the fatal influence of this complaint. 

When a wealthy parent sees a delicate child shiver at the 
freshness of the breeze, a natural tenderness leads him to 
avert this unpleasant feeling by the means he can most 
readily command, close apartments and warm clothing. 
But he thus augments that very delicacy of constitution 
he should endeavor to counteract. The variations of at- 
mospheric temperature are most sensibly felt by those who 
are cased in the thickest clothing ; as plants reared in the 
hot-house are least able to bear the blasts of winter. Con- 
trast the leaden-colored visage and the chilblain toes and 
ringers of the puny school-boy, shivering and crawling 
along the street in a winter's day, with the appearance of 
the country lad of equal years, employed all day in follow- 
ing the plough ; the surface of his body, in place of being 
chilled by the cold, is roused to a state of increased vascu- 
lar action, his countenance glows with the genuine hue of 
health, and his whole frame bespeaks elasticity and vigor. 

Surely from this example we might be taught the most 
effectual method of averting delicacy of constitution, being 
careful to modify the means according to the object we have 
to operate upon. Let the child whose wealth can com- 
mand, and whose future existence is of sufficient import- 
ance to justify such attention, reside, in a part of the 
country where the water is good and the air pure. Let 
him be abroad all day, and during every kind of weather, 
provided he is employed in - active exercise; let him be 
guarded against suddenly approaching or sitting much over 
the fire, even in winter. Let the habit of retiring early to 
bed, and leaving it early in the morning, be strictly en- 
forced. Let him wear no more clothes than are requisite 
to guard against cold, and plunge into the sea, or a river, 



CONSUMPTION. 381 

daily, during the three warmest months of summer, and 
sponge the body with cold water every day of the balance 
of the year. The phthisical habit is, in general, attended 
by a precocity of intellect, which it is of more importance 
to check than to encourage. In such instances the improve- 
ment of the mind should be considered as a secondary ob- 
ject, and may well be postponed till a certain share of 
robustness of constitution has been insured. This kind of 
corporeal education is obviously incompatible with the usual 
discipline of schools, whether private or public, and can 
only be advisable where the importance of the object justi- 
fies the various sacrifices that must be made in order to 
attain it. 

But precautions against this insidious disease are rarely 
had recourse to at so early a period of life. The buoyant 
spirits and active propensities of its destined victims rarely 
excite suspicion either in themselves or their friends of the 
approaching mischief. As the age of puberty approaches, 
other indications of the propensity to phthisis are devel- 
oped. The narrow and elongated form of the chest be- 
comes more apparent, and is chiefly indicated by the promi- 
nence of the shoulders, which stand out from it on each 
side somewhat like wings. A broad deep chest, the trans- 
verse section of which approaches the circle, affords the 
best criterion of a healthy and vigorous conformation of the 
body, not only in man, but in all kinds of quadrupeds 
which are subservient to his wants. For the support of 
life it is necessary that nearly one-half of the blood should 
circulate through the lungs in the same time that the re- 
mainder passes through the rest of the body. But if the 
lungs are prevented from expanding to their proper magni- 
tude in consequence of being confined within the limits of 
a narrow thorax, their proper blood-vessels must be propor- 
tionably diminished in number as well as dimensions, and 
on any sudden push of blood, their coats, already over-dis* 
tended, must be prone to rupture. At this period of life, 
too, there is evidently an effort of the constitution endeav- 
oring to expand every part to a state of full perfection. 



382 INFLAMMATION. 

This is evinced by frequent discharges of blood from the 
nose. The vessels of that part readily heal, but an acci- 
dent of the same kind taking place in the lungs, not unfre- 
quently lays the foundation of consumption. 

This temporary fulness of blood should be counteracted, 
by strictly adhering to a diet of the farinacea and ripe 
fruits. Animal food and fermented liquors ought to be 
rigidly prohibited. Even milk often proves too nutritious. 
Exercise should be regular but gentle. Sudden and violent 
exertions are extremely hazardous. Riding on horseback 
is preferable to any other kind of exercise. Such efforts 
of the voice as are required in singing or playing on any 
wind-instrument of music, frequently produce discharges of 
blood from the lungs ; but the practice of reading and 
reciting for some time together in a moderate tone of voice, 
tends to strengthen these organs, and to diminish the danger 
of pulmonary hemorrhage from any sudden exertion. 

During the circulation of the blood through the lungs, a 
principle necessary to the support of life is absorbed from 
the air; and various matters, the longer continuance of 
which in the body would prove noxious, are also discharged 
in the form of vapor or gas. That there is, besides, no incon- 
siderable quantity of aqueous fluid secreted and discharged 
from the lungs, every person must be convinced who has 
attended to the deposition of watery particles that takes 
place from the breath in a frosty day. Of the whole quan- 
tity of perspirable matter discharged from the surface of 
the body in any given portion of time, that exhaled from 
the surface of the lungs may be estimated as amounting to 
one-third. The skin and the lungs being both secreting 
surfaces, must also be considered as organs mutually com- 
pensating or balancing each other. If the skin be suddenly 
chilled, a larger share of perspirable matter will endeavor 
to escape by the lungs, as being an internal, and therefore 
a warmer surface. It is not surprising that this effort 
should, in a delicate organ, be productive of derangement 
and disease, and accordingly we daily hear people dating 
their first attack of pulmonary complaints from sitting in a 



CONSUMPTION. 383 

cold place after having been over-heated, from being 
thoroughly soaked with rain, or from cold-bathing in an 
improper state of the system. 

The purpose of these observations is to enforce the pro- 
priety of maintaining cutaneous perspiration, and endeavor- 
ing to render the surface of the body less susceptible of 
atmospheric variations. In persons of a phthisical habit, 
the skin is in general either dry and deficient, or clammy, 
both of which conditions betoken scabrous perspiration. 
The most efficient means of removing this morbid state of 
the surface of the body is the sedulous use of cutaneous 
friction. Why a practice on which the ancient physicians 
placed so much dependence, not only for the cure of many 
diseases, but in a preeminent manner for the preservation 
of health, should have in modern times fallen so much into 
neglect, it is not perhaps easy to account; although at 
present nothing seems to be considered as medicine, except 
what is taken into the stomach ; as if the due regulation 
of air and exercise did not furnish means of recovery, at 
least as efficacious as drugs. 

Cutaneous friction is most advantageously performed by 
means of a flesh-brush. To be of any essential use, this 
instrument ought to be of a much harder texture than those 
commonly offered for sale. The most favorable season for 
this practice is not immediately on getting out of bed. 
There exists a sensibility of the skin at that time which 
renders the application of the brush painful and unpleasant. 
After the customary diurnal evacuations of the bowels has 
taken place, the person should strip, and applying this in- 
strument to various parts of the body in succession, com- 
mencing with the chest, continue the friction till a univer- 
sal redness and glow takes place over the whole surface of 
the body. The temporary exposure of the naked body to 
the air of the chamber during this operation, accustoms the 
skin to a certain variety of temperature, while any danger 
of taking cold is completely obviated by the exercise, as a 
person ought always, if his strength permit, to rub himself. 
Though somewhat painful and irksome at first, this opera- 
tion, like all the rest of our active habits, generally becomes 
25 



384 INFLAMMATION. 

pleasant, and at length necessary, so that a person accus 
tonied to it feels himself uncomfortable if he has omitted 
for a day his usual exercise. 

From regularly persevering for some length of time in 
this practice, I have observed a very obvious alteration 
produced in the texture of the skin. It appears to acquire 
thickness, and to become mellow and pliable — a condition 
very different from that of persons disposed to phthisis, 
whose skin is commonly thin and harsh. The muscles also 
seem to derive firmness from this practice. The brush will 
also be found daily to remove no small quantity of furfur- 
aceous matter, which, whether it be inspissated perspiration 
adhering to the surface or particles of decaying cuticle, is 
certainly better away. This practice also removes every 
kind of roughness and asperity from the surface of the skin, 
which becomes beautifully smooth and polished, so that even 
as a cosmetic, having no tendency to impair health, cutane- 
ous friction may be advantageously employed. After ex- 
posure to wet, to strip and rub the surface of the body till 
it glows, is unquestionably the best means to prevent taking 
cold. 

I do not presume so strenuously to recommend friction 
of the skin as a means of supporting the healthy action of 
the external surface of the body, and of promoting cutane- 
ous perspiration, without having witnessed remarkable 
changes for the better, produced in the constitution by 
adopting and persevering in this practice. Indeed, I am 
disposed to attribute much of the benefit derived from 
exercise on horseback, as well as the good effects of a sea- 
voyage toward a mild climate, to the increase of perspiration 
produced by these modes of gestation. 

Every person suspicious of predisposition to pulmonary 
consumption ought at all times, but especially in cold 
weather, to wear a quantity of woollen clothing sufficient to 
obviate any approach to the perception of chilliness ; inde- 
pendently, however, of the actual presence of obstinate 
hoarseness or cough, I am disposed to think that the requisite 
quantity of flannel is more advantageously worn over the 
usual shirt than in immediate contact with the skin. 



CONSUMPTION. 385 

The possibility of communicating this disease by conta- 
gion is a point that has been much agitated. As a measure 
of precaution, the delicate ought to decide this question for 
themselves in the affirmative. Exhalation from the lungs 
is the mode by which infectious diseases are most generally 
propagated ; and from analogy, we might infer that air im- 
pregnated with the effluvia of these organs in a state of 
ulceration would have a tendency to excite diseased action 
of a similar kind if received into the lungs of a person 
previously disposed to this complaint. I have seen more 
than one instance of a husband who appeared to have no 
previous disposition to consumption being affected with a 
distressing cough, which continued to harass him for months 
while his wife was lingering under that disease. On one 
melancholy occasion, I witnessed the successive deaths of 
three young ladies, two of whom, in my opinion, decidedly 
caught the disease in consequence of their sedulous atten- 
tion, during the progress of the indisposition, to her who was 
first affected, who evidently was of phthisical habit, which 
was not apparent in either of the others. 

If the presence of the symptoms which have been already 
described as characterizing this disease renders its existence 
no longer equivocal, the person so affected ought, without 
delay, to migrate toward a warmer climate. Should cir- 
cumstances render this expedient impracticable, the next 
best plan a phthisical person can adopt is to remove into a 
low and rather damp situation. The fatal event of pul- 
monary consumption is uniformly accelerated by residing in 
an elevated region. There are even instances on record of 
phthisis making its appearance in families, previously unaf- 
fected by it, on changing their place of residence from a 
level to a hilly country. In Holland, pulmonary consump- 
tion is a disease of comparatively rare occurrence. The 
same situations that predispose to ague are unfavorable to 
ihe attack of phthisis, as if these two states of the consti- 
tution were incompatible with each other. The physicians 
of ancient Rome were accustomed to send their consumptive 
patients to the low and marshy land of Egypt, Cicero, the 
celebrated orator, who in his youth was threatened with 



386 ' INFLAMMATION. 

consumption, as the hollow temples and sharp features of 
his remaining busts abundantly testify, travelled into Egypt 
for the recovery of his health. 

CARCINOMA, OR CANCER. 

General Observations. — There is scarcely an organ or tissue 
in the body which may not be attacked by this malignant 
and terrible disease. It occurs most frequently in women, 
on account of the liability of the breast and uterus to be 
affected by it; otherwise, it would seem to be more common 
in men, since the skin, bones, and digestive organs are more 
prone to it in the male than in the female sex. It is very 
uncommon in children ; when it occurs in them, it is gene- 
rally located in the bones or in the eye, or, very rarely, in 
the testicle. 

A cancer may be described as a local manifestation of a 
specific disease of the blood, having incorporated in it pe- 
culiar morbid materials which accumulate in the blood, and 
which its growth may tend to increase. As it is of consti- 
tutional origin, so the removal of the local manifestation 
does not effect a cure ; but the cancer returns either in the 
seat of the original disease, or in some other parts. More- 
over, when the primary affection has existed for a variable 
period, secondary deposits are very apt to be formed in the 
lymphatic glands, lungs, liver, spleen, etc. Although the 
tendency of cancer is to increase constantly and rapidly 
until life is destroyed, yet in a very few instances it becomes 
latent ; that is to say, after it has reached a certain line of 
development, it remains in a state of quiescence, neither 
advancing nor receding. Sir B. Brodie refers to a case 
where the cancer was quiescent for twenty-five years ; Dr. 
Babington knew an instance in which scirrhus of the mamma 
[breast] was stationary for twenty-four years ; and Sir 
Astley Cooper attended two women in whom the period of 
latency was respectively seventeen and twenty-two years. 
Equally rare is the spontaneous cure of cancer by inflamma- 
tion, ulceration, and sloughing, or by fatty or calcareous de- 
generation ; yet it is certain that nature has by these means 
effected at least temporary if not permanent cures. 



CANCER. 387 

If any cancerous growth be minutely examined, it will 
be found to consist of a peculiar formation called nucleated 
cells, or " cancer cells/' and of their free nuclei or central 
portion; and a milky fluid or semi-fluid mixture termed 
" cancer-juice." The cancer cells and juice are either infil- 
trated into previously healthy tissues, or they are con- 
tained in a stroma or bed of new fibrous tissue. The 
cancer-cells are of various shapes, being round, oval, fusi- 
form, triangular, or elongated into one or more sharp 
processes ; they vary in size from the to?> to the sso o of 
an inch, the medium being to 1 ™; and they chiefly resemble, 
in structure and aspect, the secreting gland-cells. On 
magnifying a specimen of scirrhus about two hundred 
diameters, the cells will be seen containing a comparatively 
large, regular, oval or round, and w T ell-defined nucleus ; 
sometimes two nuclei exist in the same cell; and each 
nucleus has one or two nucleoli. Moreover, mingled with 
these ceUs we find free nuclei, and numerous degenerated 
cancer-cells; some of these cells appearing withered and 
full of oil-globules, others being transformed into granular 
matter, in the debris of which the nuclei lie loose. 

Varieties of Cancer. — There are three principal varieties 
of malignant disease : they are, Scirrhus, or Hard Cancer ; 
Medullary, or Soft Cancer; Epithelial, or Skin Cancer. 

Scirrhus, or Hard Cancer. — This is the most frequent 
form of cancer. It is seen occasionally in the stomach, in 
the upper part of the rectum, and elsewhere; but most 
frequently, by far, in the female breast. 

In the breast it is found as an infiltration, affecting part 
or the whole of the mammary gland. The diseased mass 
is extremely hard, correspondingly heavy, and inelastic ; 
the increase in size is not great, for the part of the gland 
affected is not much larger than it was in health. After a 
variable period, the tumor, with the proper tissues of the 
breast in contact with its surface, and the skin, which is 
often adherent to it, ulcerates ; a foul, excavated, spreading 
ulcer, with everted edges, being formed ; from which there 
is a constant sanious discharge, and very often attacks of 



388 INFLAMMATION. 

hemorrhage. The ulceration sometimes extends from the 
skin inwards ; sometimes from the substance of the cancer 
outwards. The amount of suffering varies ; occasionally 
the pain is very slight, but generally it is severe, lancinating, 
and most exhausting. 

As the local disease advances, the health fails, and the 
cancerous cachexia becomes fully established. This condi- 
tion has been well described by Sir Charles Bell : " The 
general condition of the patient is pitiable. Suffering much 
bodily, and every thing most frightful present to the imagi- 
nation, a continual hectic preys upon her, which is shown 
in increasing emaciation. The countenance is pale and 
anxious, with a slight leaden hue ; the features have 
become pinched, the lips and nostrils slightly livid; the 
pulse is frequent; the pains are severe. In the hard 
tumors the pain is stinging or sharp ; in the exposed sur- 
face it is burning and sore. Pains, like those of rheumatism, 
extend over the body, especially to the back and lower 
part of the spine; the hips and shoulders are subject to 
those pains. Successively the glands of the axilla, and 
those above the clavicle, become diseased. Severe pains 
shoot down the arm of the affected side. It swells to an 
alarming degree, and lies immovable. At length there is 
nausea and weakness of digestion. A tickling cough dis- 
tresses her. Severe stitches strike through the side ; the 
pulse becomes rapid and faltering ; the surface cadaverous ; 
the breathing anxious ; and so she sinks." 

Scirrhus of the breast is very rare in men ; it occurs in 
women most frequently between the ages of forty-five and 
fifty. 

Records, made by M. Paget, of 139 cases of scirrhus of 
the breast, watched to their conclusions, or to their sur- 
vivals beyond the average duration, give the following 
results: In 75 not submitted to operation, the average 
duration of life after the patient's first observation of the 
disease, has been 48 months. In 64 submitted to opera- 
tion, and surviving its immediate consequences, the corre- 
sponding average has been a little more than 52 months. 



CANCER. 389 

The longest duration of life in the former class has been 
216 months ; in the latter class 146 ; the shortest in the 
former was 7 months; in the latter 71. 

Medullar?/, or Soft Cancer. — Medullary, or encephaloid, 
or cerebriform or brain-like cancers are of two kinds — soft 
and firm ; the former being the most frequent. In either 
condition they are found in about equal proportion as sepa- 
rable tumors or as infiltrations. As separable tumors, when 
occurring in the testicle, the breast, the eye, the inter- 
muscular and other spaces in the limbs; as infiltrations, 
when occupying the substance of the uterus, the alimentary 
canal, the serous membranes, and the bones. In either 
form their course towards a fatal career is rapid, the average 
duration of life, from the patient's first observation of the 
disease, being little more than two years ; moreover, they 
occur at an earlier age than other kinds of cancer, being 
sometimes met with before puberty. The soft medullary 
tumors are commonly round or oval, and present to the 
touch a sense as of the fluctuation of some thick fluid, so 
that the most experienced are often deceived. They are 
very vascular ; the material composing them resembles 
brain substance, partially decomposed and broken up; they 
yield abundance of cancer-juice on being pressed or scraped ; 
and they frequently contain extravasated blood. The firm 
medullary cancers are elastic and tense, but not hard, like 
scirrhus ; in their shape and size they resemble the soft ; 
they may possess distinct investing capsules, or they may 
extend into the substance of organs. 

Epithelial Cancer. — Some difference of opinion exists as 
to whether this disease is really a form of cancer, or 
whether it is not an affection sui generis, consisting of an 
infiltration of cells of scaly epithelium, with a serous liquid 
different from cancer-juice. Hence some authors speak of 
it as "epithelioma," or as "cancroid" affection. In its 
clinical history, however, it resembles cancer; inasmuch as 
it returns after being removed by operation, it is prone to 
incurable ulceration, it affects the lymphatics seated near 
it, and it destroys the patient; but it is peculiar in two 
respects — it is very little liable to multiplication in internal 



390 INFLAMMATION. 

organs, and it appears often to be produced by local causes 
only. As pathologists seem divided upon this question, 
it will be better to treat of it in this place as if it were 
undoubtedly a true form of cancer; a plan which has at 
least this recommendation, that it is adopted -by Mr. 
Paget. 

This disease is generally located in or beneath some 
portion of skin or mucous membrane, its most common 
seats being the lower lip, the tongue, the larynx, the 
nymphse, the labia majora, the cervix and lips of the 
uterus, and, in chimney-sweeps, the scrotum. True, 
" cauliflower excrescence of the uterus" is in all probability 
always a variety of epithelial cancer, commencing on the 
surface of the os uteri in the form of small papillary or 
villous eminences, which, by their growth, expansion, and 
branching, take on the peculiar cauliflower appearance. It 
is a rare disease. 

Epithelial cancer is generally thought to occur oftener 
in the male than in the female sex. It is most common 
after the age of 50. .When once established, it gradually 
progresses to destroy life, but more slowly than medullary 
cancer ; rather less than four years being the average dura- 
tion of life from the commencement. Its malignancy seems 
greater when it is seated on the tongue or on the penis, 
than when on the scrotum or the lower extremities ; and 
the removal of the disease by operation probably gives a 
better chance of recovery than the excision of any other 
variety of carcinoma. The essential character of this 
disease is, that it is composed for the most part of cells 
resembling — according to some authors, identical with — 
the tessellated or scaly epithelium lining the inside of the 
mouth ; these cells being infiltrated, together with a juice 
or serous fluid, into the interstices of the affected tissues. 

Causes of Cancer. — With regard to the causes of this 
disease, but little is known. All classes of society are 
equally subject to it ; the rich and poor, the idle and indus- 
trious, the gay and the melancholy, all suffering from it in 
equal proportions. The only known predisposing causes 
are thus summed up by Dr. Druitt : 1. " Descent from a 



CANCER. 391 

cancerous parent, which seems to have some slight influ- 
ence, and was found by Lebert to exist in about one-seventh 
of a certain number of cases. 2. Sex, for cancer is at least 
from one-third to one-half more prevalent in the female. 
3. Age, because nearly half of the entire number of cases 
occur between forty and sixty. Lastly, Although cancer is 
not contagious in the ordinary sense of the term, there 
seems reason for believing that, if fresh cancer-cells are 
introduced into the blood, they may be deposited and pro- 
pagate themselves. The experiment has been tried on dogs 
by Langenbeck and by Lebert, and cancerous tumors were 
found in various parts, when the animals were killed some 
time afterwards ; yet it must be remembered that some of 
the tumors found in these cases may have existed before 
the inoculation." From all this, it is evident that our 
knowledge of the causes of this disease is very slender. 
In the great majority of cases the patient is unable in any 
way to account for its origin ; very frequently — in scirrhus 
of the breast especially — the tumor is only discovered by 
accident; and it is almost certain that mental anxiety, 
peculiar temperaments, particular occupations, injuries, etc., 
have nothing to do with producing the cancerous diathesis. 
In listening to the histories of patients afflicted with cancer 
of the uterus, I have been struck with the frequency with 
which they have told me of the loss of one or more of 
their relatives from phthisis. The same circumstance has 
been noticed by Mr. Zachariah Laurence, who seems rather 
inclined to entertain the opinion that there may be some 
connection between the two diseases. 

Treatment of Cancer. — The treatment of cancer is at 
present — as far as I positively know — in just the same un- 
satisfactory condition as was that of phthisis only a few 
years ago. But inasmuch as we have every ground for be- 
lieving that well-marked cases of pulmonary consumption, 
which would have been regarded as utterly incurable ten 
years since, are now sometimes restored to health by the 
aid of medicine ; so we have every reason to trust that at 
no distant day cancer may be made to yield to some remedy 
or combination of remedies, yet to be discovered. In the 



392 INFLAMMATION. 

meantime much may be done to relieve the patient's- suffer- 
ings, and to prolong life. 

Palliative Treatment.— The great indication is to keep up 
the constitutional powers to as near the standard of health 
as the disease will allow, by tonics, nourishing food, pure 
air, warm clothing, great cleanliness, mental occupation, and 
by preventing or relieving pain, and, if possible, prevent the 
sufferer from applying to those callous charlatans who will 
make the most solemn assertions of their ability to cure 
him, until he either sinks into the grave, or has expended 
every dollar that he possesses. Moreover, it is our duty to 
make every effort to give even temporary relief; for, as 
Bacon has well said, "I esteem it the office of a physician, 
not only to restore health, but to mitigate pain and dolors, 
and not only when such mitigation may conduce to re- 
covery, but when it may serve to make a fair and easy 
passage." 

The best means to adopt in addition to all known hygienic 
measures for the maintenance of the general strength are, 
first, to do all that is possible to relieve pain ; which may 
be done either by the administration of opium, conium, or 
henbane, or by the application of intense cold. By this 
alone much good may be affected ; but we must, secondly, 
try to improve the blood by ferruginous tonics, and by the 
use of the most nutritious kinds of food. Wine, beer, 
milk, and different varieties of animal food, must be freely 
given ; bark and cod-liver oil will often be valuable ; and the 
patient must breathe pure air. Thirdly, the growth of the 
cancer may perhaps be checked by the bromide of potas- 
sium, or by the iodide of iron, or by the iodide of arsenic. 
By these measures, perseveringly used, mental and bodily 
ease may be given and life prolonged even for a few years. 

Curative Treatment. — In attempts to effect a cure, one of 
three plans has usually been followed ; viz., either excision; 
removal by caustics ; or the promotion of absorption by 
methodical compression, sometimes combined with the ap- 
plication of intense cold. 

First, as to Excision. — A general opinion can only be 
formed with great difficulty, since the views of surgeons 



CANCER. 393 

are so divided. But I think no one will deny that extirpa- 
tion by the knife is quite insufficient to effect a cure ; it may 
relieve the local distress, it may prolong life for a few 
weeks, and, as chloroform renders the operation painless, it 
may be sometimes worth while resorting to it to gain these 
objects. With regard to the time at which it is best to 
resort to the knife, Mr. Spencer Wells observes : " It is not 
to use it in. the early stages of cancer, not to use it unless 
the cancer is actually ulcerated, or growing so fast that the 
skin is about to give way. In such cases, especially where 
an open cancer gives great pain, and is wearing away the 
patient by bleeding or profuse fetid discharge, the knife is 
used in the hope of relieving suffering, and prolonging, not 
saving life. In some other cases, where a cancer causes 
great mental anxiety to a patient, you may remove it at 
her earnest entreaty, after explaining fairly the danger 
of relapse." While speaking of the knife, it may also be 
mentioned that attempts have been made to destroy malig- 
nant tumors by lowering their nutrition; with which ob- 
ject practitioners have tied the chief nutrient arteries of the 
affected part. No real success has attended these efforts. 

Secondly, Removal by Caustics. — This method has found 
many advocates in the present day; and it possesses at 
least this advantage, that it may be useful in deeply ulcer- 
ated and some other cancers, where the knife is objection- 
able. The chief agents which have been used are arsenical 
pastes, chloride of zinc, chloride of bromium, sulphate of 
zinc, manganese cum potassa, the strong mineral acids, and 
the concentrated alkalies. The arsenical pastes cannot be 
employed without great caution, inasmuch as their action is 
not merely local, but pervades the whole system. M. 
Manec, of the Salpetriere Hospital, Paris, has largely used 
them ; he believes that arsenic has a peculiar destructive 
affinity for cancerous growths, and that its action does not 
extend to healthy tissues. His formula — the only one 
which should be tried — is one part of arsenious acid to 
seven or eight of cinnabar, with four of burnt sponge, made 
into a paste with a few drops of water. He does not apply 
it to a surface of greater extent than the size of a ten cent 



394 INFLAMMATION. 

piece at each application ; and he states that the quantity 
of arsenic absorbed from such a surface never produces un- 
pleasant symptoms. Should severe pain arise, it may be 
mitigated by applying bladders containing ice and salt. 

The chloride of zinc is a valuable agent, especially as 
there is little to fear from its absorption. The epidermis 
must first be destroyed by a blister or by strong nitric acid ; 
and the caustic is then to be applied, in quantity varying 
with the amount of destruction required. Dr. Fell's plan 
of treatment consists in the use of chloride of zinc com- 
bined with a perennial plant known by the name of puc- 
coon, but described by botanists — owing to the blood-like 
juice which exudes from it w x hen cut — as the Sanguinaria 
Canadensis, or blood-root. Together with this application, 
the general health of the patient is attended to ; a nourishing 
and sustaining diet is allowed ; and the puccoon is adminis- 
tered thrice daily, in half-grain doses. Frequently, also, 
Dr. Fell combines with this drug the sixteenth of a grain 
of the iodide of arsenic, and one grain of the extract of 
conium. The chloride of hromium has been highly praised 
by Landolfi, who uses it made into a paste with flour, or 
combined with other caustics. The proper method of ap- 
plying the paste, is on a piece of linen cut to the size of 
the part to be destroyed. At the end of twenty-four hours 
the rag is removed ; the slough separates after a few days ; 
and the sore is then dressed with lint soaked in a solution 
of chloride of bromium — ten grains to twenty grains in 
water. The patient takes a pill morning and evening, con- 
taining one-tenth of a grain of the chloride. Sulphate of 
zinc has been strongly recommended by Professor Simpson, 
who says that when it is applied to an open and diseased sur- 
face, it acts as a safe, most powerful, and manageable caus- 
tic. It may be employed in the form of a simple fine 
powder, or as a paste made with glycerine — one ounce of 
the salt to one drachm of glycerine ; or as an ointment — 
one ounce to two ounces of iard. When used in either way 
to an open or ulcerated surface, the ptrt to w T hich it is 
applied is rapidly destroyed to a depth corresponding to the 
thickness of the superimposed layer 5 the slough usually 



CANCER. 395 

separates on the fifth or sixth day ; and there is left be- 
hind, if the whole morbid tissue be removed, a red, granu- 
lating, healthy wound, which rapidly cicatrizes. Until all the 
disease is destroyed, the applications must be repeated. The 
sulphate of zinc will only act as a caustic to a broken or 
open surface; hence, when the epithelium is entire, this 
must be removed by a small blister, or by a strong acid. 
Its application gives rise to local pain and burning in most 
instances, but never to any constitutional disturbance. The 
manganese cum potassa is recommended by Mr. Weedon 
Cooke in ulcerated cancer ; it is efficacious, causes but little 
pain, removes all unpleasant odor from the sore, and does 
not injure the general health. It may be used as a powder, 
or made into a paste with water ; it must be applied in a 
layer as thick as the tissue to be destroyed. By means of 
carrot poultices the eschar drops off in three or four days ; 
when, if necessary, the manganese is reapplied until the 
diseased mass is all destroyed, and the subjacent healthy 
tissues granulate and cicatrize. With regard to the strong 
mineral acids and the concentrated alkalies, but little need be 
said. If the former be used, sulphuric acid, made into a 
paste with saffron, will prove the most efficacious ; if the 
latter, the Vienna paste. 

The following recipe was sent to the author by Mr. Fu- 
gitt, of this State, who has acquired some notoriety as a 
cancer-curer. It is supposed to be substantially the same 
with that on which the Rev. Dr. January principally relies. 

Recipe. — Take Pulverized Beech Drops, 29 grains; Red Puccoon Root, 3 
grains ; Pure Arsenic, 1 \ grains. Mix thoroughly together, and keep in a dark 
place. 

Make Ointment. — Take a handful of slippery-elm, a handful of mullen, and a 
handful of the weed life-everlasting : put them in a pot, cover them with water, 
and boil until you get the strength thoroughly out : then remove the herbs, and 
strain the liquor : then cleanse the vessel, return the strained liquor, and boil 
slowly down to one pint : then add about one pound of white resin and one pound 
of mutton suet: continue to simmer until the water is out. While the mixture 
is cooling, you must stir and work it as a shoemaker does his wax. 

Application, — If the Cancer be not raw, scarify it ; then take a piece of thin 
cloth, half an inch larger in diameter than the cancer, and spread the salve over 
it, and apply it to the cancer at night ; the next morning remove it, and put on a 
good coat of the powders, with the salve only on the sound flesh, so as to hold the 
powders on the parts which are raw. Let the powders remain on thirty-six hours. 
Then take them off, and put on the salve plaster, which must remain twelve hours. 



396 INFLAMMATION. 

Then clean off the cancer, and apply the powders again, suffering them to remain 
for thirty-six hours, as before, thus alternating until a cure is performed. If the 
dead flesh should not become soft, and come away of itself, you may hasten the 
operation by cutting it away before applying the powders. Continue a plaster of 
the salve until the cancer cures up, keeping all water from the cancer from the 
commencement. 

Thirdly. There remains for consideration the plan which 
chiefly has for its object the promotion of absorption by 
methodical compression^ ivith or without the application of in- 
tense cold. Pressure is supposed to act beneficially in can- 
cer by diminishing the supply of blood, and hence of 
nourishment, to the tumor ; by depriving the cells of the 
space necessary for their growth ; by injuring them from 
direct violence, and by promoting their absorption. Since 
compression was first proposed, by Mr. Samuel Young, in 
1809, numerous cases have been treated by it, by different 
surgeons ; and certainly the results seem to have been more 
favorable than those produced by any other mode. The 
pressure must be methodically and perseveringly applied. 

The efficacy of intense cold depends on its arresting the 
circulation, producing some change in the microscopic cells, 
and in altering the vitality of the part : it not only gives 
relief from pain, but is said to arrest the progress of the 
disease. In cancer of the uterus, the frigorific mixture — 
equal parts of ice and salt — may be applied, by means of a 
gutta percha speculum, daily, for fifteen or thirty minutes, 
or even oftener. 

But the result of my own experience and observations 
leads me to believe that all these means will very genera U} r 
fail in performing a permanent cure when applied to open 
cancer ; but, in the early stage, before ulceration has taken 
place, I have frequently extirpated tumors which I believed 
to be cancerous, which never returned. I always, however, 
put the patient upon the alterative treatment recommended 
in scrofula. I have also cured many cases of scrofulous 
and syphilitic ulcers, which cancer-doctors had pronounced 
true cancer, and had failed to cure. But in every instance 
in which the ulcer presented the true cancerous character I 
have failed to do more than retard its progress and lessen 
the patient's sufferings. 




POSTERIOR VIEW OF THE MUSCLES OF THE BODY. 



SYPHILIS. 397 



SYPHILIS. 

The reasons for introducing this iniquitous and loathsome 
disease at all into this work are, that, in many of its consti- 
tutional forms, it so nearly resembles scrofula as to render 
an accurate description absolutely necessary, in order to 
distinguish them ; and, as they require to be somewhat dif- 
ferently treated, it often becomes of the greatest importance 
that the two diseases should not be confounded or mistaken 
for each other. Then, the true scrofulous diathesis in chil- 
dren is often the result of a syphilitic taint in the parent ; 
and though not to be distinguished from other cases in its 
external manifestations, yet requires a modified or peculiar 
treatment, making its history become very important. Then 
again, when we consider that syphilis is often communicated 
to innocent individuals, even in its primary form, it is very 
essential that this form should also be described, in order 
that it may be recognized and properly treated before 
serious, and perhaps irreparable, injury is sustained by ihe 
innocent sufferer. And then again, the disease is often con- 
tracted by servants, and should be understood by those who 
haA^e their management, that proper means may be timely 
resorted to for its suppression. Otherwise, if only the 
guilty individuals were to suffer, this disease would have 
been passed over in silence, and the subjects referred to the 
physician for counsel and treatment. 

Syphilis, or pox, is a specific disease, communicated by a 
specific poison, received by contact with an infected person. 

The syphilitic virus may take effect upon any part of the 
surface which happens to have a break in the cuticle or ex- 
ternal covering of the skin, or a mucous membrane. The 
first symptom is a mere itching of the part; but soon a 
little watery blister is formed, or a slight watery exudation 
takes place from the surface, if it has been divested of the 
scarf-skin by scratching or otherwise. This blister or exu- 
dation sometimes dries, and nothing more than a hardened 
surface is left ; in this case the virus seems to be almost 
entirely absorbed, and secondary symptoms are certain to 
follow. In this way persons are occasionally found to have 



398 INFLAMMATION. 

the disease fully developed in its secondary or tertiary forms, 
without having suspected any danger, the primary symptoms 
having been so slight as to have escaped notice. 

But generally, after a few days, suppuration takes place 
in the seat of the inoculation, and ulceration removes the 
skin and under layer of areolar tissue, forming a cup-like 
cavity with raised indurated edges, but very frequently the 
ulcer remains entirely superficial. In either case the secre- 
tion is rather scant and thin. Not much soreness is usually 
felt, and but for the after-consequences, the disease would 
appear to be of a trifling nature, but ulceration goes on 
enlarging the area of the ulcer, and, if not arrested, may 
finally destroy much of the soft parts. In the meantime, 
the virus extends along the absorbents to the nearest gland, 
which takes on inflammation, which, if not attended to in 
the early stage, ends in suppuration and a destruction of 
the gland. When the primary sore matters freely, there is 
less danger of the poison being absorbed, and when the 
virus is arrested by a gland and brings about active inflam- 
mation, it is not so likely to progress any farther, and the 
true constitutional disease may never be developed. The 
longer the duration of the primary venereal sore, the 
greater the probability of secondary symptoms ; moreover, 
the worse the state of the general health at the time of 
contracting the primary ulcer, the greater the risk of the 
constitution subsequently suffering. Many authorities 
believe that constitutional syphilis may be communicated 
from an infected to a healthy person without the inter- 
vention of primary disease, especially where there is 
frequent contact between two parties. Secondary skin 
diseases may be so communicated from the husband to the 
wife ; or it is probable that the husband, having constitu- 
tional syphilis, may taint the ovum, and that through the 
latter the mother may b.e infected. ' Tertiary symptoms 
may appear at a very long period after the primary disease, 
and generally after the secondary symptoms have dis- 
appeared. According to Mr. Parker, the diseases which 
have been termed tertiary are deep-seated affections of the 
skin, as tubercles ; and affections of the glands and bones, 



SYPHILIS. . 399 

as periostitis, exostosis, caries, and necrosis. To these may 
be added various internal affections, as yet neither well 
known nor described. The tertiary symptoms are not 
hereditary under any specific form of venereal affection. 
The children of persons thus affected are very commonly 
scrofulous, phthisical, or predisposed to cancerous diseases. 
Many of the constitutional forms of disease are capable of 
propagation by contact or inoculation; and in persons 
cohabiting as man and wife, a syphilitic symptom existing 
in one is very commonly produced in the other in precisely 
the same form. As soon as constitutional syphilis manifests 
itself, attempts should be made, to cure it. Pregnancy even 
is no bar to the treatment, for the disease is much more 
likely than the remedies to produce abortion. 

Symptoms. — Constitutional syphilis very frequently mani- 
fests itself by the production of certain cutaneous diseases ; 
by ulcers on the skin ; by warts and mucous tubercles ; by 
alopecia or baldness, loss of the eyebrows and eyelashes ; 
by inflammation and ulceration about the root of the nails ; 
by superficial ulcerations on the tongue, lips, or pillars of 
the fauces ; by ulcerations of the larynx ; by enlargement 
of the testicles — syphilitic sarcocele ; by diseases of the 
periosteum and bones ; and, in a few instances, by a peculiar 
form of bronchitis. 

The syphilitic cutaneous eruptions are of various kinds. 
They are generally chronic ; of a bronze or copper color ; 
frequently squamous or scaly, and prone to excoriate ; 
sometimes assuming the form of tubercles of a livid or 
brown color, surrounded by a coppery areola, and having 
a tendency to degenerate into foul, offensive ulcers ; while 
occasionally these affections merely take on the appearance 
of brown or dirty yellow stains. Loss of hair from syphi- 
litic causes seldom occurs without other symptoms ; it is 
especially combined with the formation of scurf on the 
scalp, and w T ith inflammation of the roots of the nails, so 
that these latter structures crack and break easily, or even 
fall off. The syphilitic ulcers of the fauces, tonsils, and 
pharynx are often excavated, covered by an ash-colored 
slough, and surrounded by a livid, unhealthy appearance of 
26 



400 INFLAMMATION. 

the mucous membrane. Occasionally they slough, and 
extend rapidly ; they give rise to pain and difficult deglu- 
tition, and they are always attended with more or less con- 
stitutional disturbance. Ulcerations of the nostrils are also 
not uncommonly the only symptoms of the general infection 
of the system; they give rise to offensive discharges, and 
often result in a destruction of the soft bones of the nose. 
Enlargements upon the superficial bones, called nodes, are 
not uncommon, which appear to be caused by a morbid 
deposit between the periosteum and bone ; they are oftenest 
found upon the leg, arm, or about the head. 

A volume might be written upon the history and treat- 
ment of this disease, but the above must suffice as to its 
appearances, and I will not take up space by detailing the 
different modes of treatment which have been devised and 
recommended by standard authors ; though not intimating 
by this that they embrace nothing reliable, but in order to 
be brief, and not confuse the minds of my readers by 
diverse recommendations, we will close the observations upon 
this subject by giving our own simple plan of procedure, 
which is to let the primary disease alone, merely keeping 
it cleansed by a frequent use of castile soapsuds : the soap- 
suds promote a free discharge from the ulcer more certainly 
than any other application, and thus tend to prevent an 
absorption of the virus. Most practitioners cauterize the 
surface of the chancre, or primary sore ; but I was taught 
by Professor Dudley to let the chancre alone, so that it 
might serve as an index by which the progress of the cure 
can be known. It is true that if the original seat of the 
inoculation were cauterized before any absorption had taken 
place, this measure would, by destroying the virus, prevent 
any secondary symptoms ; but as few cases are seen or 
brought into notice until absorption has already taken 
place, there can then be no advantage obtained from cauter- 
izing, and we will have no means of determining when the 
disease is radically cured. But if the primary sore is not 
disturbed, it will inform us exactly when the general 
remedies have conquered the disease, for it will improve in 
appearance as the cure progresses ; or even if no apparent 



SYPHILIS. 401 

alteration takes place, yet when the general disease yields, 
the sore will heal very suddenly ; sometimes so suddenly 
that the patient cannot tell when it took place. For bubos, 
or inflammation and swelling of the glands, spoken of, I 
find nothing better than equal parts of chloroform liniment 
and tincture of iodine applied freely to the rising night and 
morning, and covered with a slippery-elm poultice, or folds 
of soft linen kept saturated with whiskey. If it be dis- 
covered that the gland will suppurate, it then is best to 
hasten the process by applying the lye poultice, etc. The 
general treatment which I have found to succeed is the 
same recommended in scrofula, with the addition of mercury 
in some form. I usually commence by giving blue-mass 
every night in pretty full doses — say from ten to twenty 
grains — and a tablespoonful of epsom salts in the morning. 
After this has been repeated three or four days, I then 
commence with the following prescription : comp. syr. val., 
or fever syrup, and comp. syr. of sarsaparilla, each eight 
ounces ; iodide of potassse, one ounce ; bi-chloride of mer- 
cury, or corrosive sublimate, thirty grains : of this I order 
a large teaspoonful after each meal; or the mercury may 
be omitted from this prescription, and a blue-mass pill taken 
every night. . No other treatment has been found necessary 
in my practice for many years, and I never change a sure 
plan for one less certain, or for an untried one. 

If there should be any doubt as to whether the disease 
be scrofulous or syphilitic, it may be decided by the effect 
of the treatment; for if scrofula be mistaken for syphilis, 
and the mercury added to the prescription, the disease will 
almost invariably get worse ; or, if syphilis be mistaken for 
scrofula, the remedies will often fail of producing the amend- 
ment which usually follows their exhibition. But some- 
times the two diseases, are combined, and then it becomes 
difficult of management. I once had a case of this kind 
which annoyed me exceedingly ; the patient was a negro, 
who had previously presented decided scrofulous tendencies, 
who applied to me for the treatment of an injury received 
in the groin by falling through an iron grating on the side- 
walk; there was no doubt of the correctness of his state- 



402 INFLAMMATION. 

ment, as the signs of a recent contusion were easily seen, 
and phlegmonous inflammation of an active kind had super- 
vened. But, after these active symptoms had been allayed 
by poultices, etc., and I expected to see the parts heal, I 
was perplexed to find a suspicious condition of the ulcer, 
and accused the boy of having played false ; but, as he 
stoutly denied any thing of the kind, and as I saw other 
symptoms of scrofula, I decided that the scrofulous taint 
had affected the sore, and put him upon the proper treat- 
ment, Some amendment took place ; but the disease lin- 
gered until copper-colored blotches on the surface revealed 
the secret, that, besides getting hurt by the fall, and having 
strumous predisposition, he had also been inoculated with 
the syphilitic virus. An addition of a blue-pill every night 
to the other treatment finally succeeded in clearing the 
skin of the blotches ; it was then discontinued, and the 
alterative alone given, which finally restored him to perfect 
health. 

CHANCROID. 

Since this work was first published very careful and ex- 
tensive investigation of the subject of syphilitic diseases 
has proven, to the entire satisfaction of the profession, that 
there is a disease which resembles true syphilis, and has 
been confounded with it, embracing, in fact, by far the 
greater number of cases known as syphilitic, which never 
becomes constitutional, and is never benefited by the use 
of mercury. This disease is known as chancroid, or soft 
chancre. 

It may be distinguished from true syphilis by the primary 
sore having an abrupt and ragged margin, and the bottom 
of the ulcer being covered by a pretty thick layer of very 
tenacious grayish secretion; by there usually being several 
ulcers at the same time, whereas in true syphilis the chan- 
cre is nearly always solitary, and by the discharge being 
much more profuse. 

As the confounding of this disease with true syphilis has 
given rise to much confusion in description, and led to very 
grave mistakes in practice, it becomes important that each 



CHANCROID. 403 

should be described, so as to enable the reader to make a 
correct diagnosis. Great mischief has often been done by 
pushing the mercurial treatment in cases of chancroid, as 
this medicine is never of advantage, and generally highly 
injurious in its treatment. The distinctions recognized be- 
tween chancroid and syphilitic ulcers are, the first has abrupt, 
ragged edges, the second is cup-shaped, or may remain even 
with the surrounding surface; the first has a thick, glairy, 
tenacious, and copious deposit in the bottom, in the second 
the discharge is thin, scanty, and possesses no tenacity ; in 
the former the ulcers are soft underneath, while in the lat- 
ter they always have a hard, indurated base : the chancroid 
usually appears in several places at the same time, and is 
readily extended to new points by inoculations produced 
by transferring the matter by scratching; in true syphilis 
there is rarely more than one ulcer, and it can not be trans- 
ferred to new points on the same person by inoculation. 
Then, chancroid never extends beyond the first gland, and 
consequently never becomes constitutional, and is therefore 
not amenable to constitutional remedies further than as 
they may act upon general principles in subduing an in- 
flammatory state of the system, or correcting any morbid 
condition which may interfere with the proper effect of 
local remedies. 

The discovery of the distinction between syphilis and 
chancroid has marked a new era in the management of 
venereal diseases. The confounding of the two forms of 
venereal ulcer has been, as we have said, the cause of much 
confusion in description, and of very grave mistakes in 
practice; for, as chancroid will run its course and get well 
spontaneously or under very simple treatment, and as this 
form is much oftener met with than true syphilis, it led 
many practitioners to believe that mercury was unneces- 
sary in the treatment, emboldened charlatans to advertise 
that they could cure all forms of venereal diseases without 
mercury, and their apparent success would confirm them 
in the delusion, and secure a run of custom. But when- 
ever such practitioners get hold of a case of genuine syph- 
ilis it runs on, in defiance of their boasted specifics, through 



404 INFLAMMATION. 

all its terrible stages, causing death in the most loathsome 
and terrific form known in this sin-cursed world. 

Then, again, when the physician had adopted the idea, 
which but very recently was sustained by the very highest 
authority, that mercury was essential in every case of syph- 
ilitic ulcer, and ought to be pushed until the disease yielded, 
the motto being "try and try again," the consequences*were 
often little less disastrous than in the former case, the con- 
stitution being destroyed and even the bones rotted by the 
abuse of this potent medicine. The reader will therefore 
perceive how vitally important it is that a correct diagnosis 
should be made. 

The profession has, as yet, discovered no specific for 
chancroid; it yields very kindly, in most cases, under the 
influence of cleanliness and simple dressings. In uncom- 
plicated cases I have found nothing necessary to be done 
more than to cleanse the ulcer once or twice a day with 
castile soap suds, and then dust it with a powder composed 
of equal parts of calomel and pulverized nutmeg. There is 
no ' danger of the calomel being absorbed, as the soap will 
cause the ulcer to matter sufficiently to prevent that taking 
place. If the habit is full, I order as much of the saline 
mixture, taken daily in broken doses, as will keep the 
blood cool and the bowels open. The diet in such cases 
should be light, but in cases which are below the healthy 
standard I order nutritious diet and tonics. If there exists 
any other disease, or a depravity of the constitution, each 
case must be treated as such complications will indicate. 

GONORRHEA, OR CLAP. 

When this work was first published there was nothing 
said upon this disreputable disease, but, for reasons then 
given for introducing a chapter on syphilis, it is thought 
best to give a short, plain description of gonorrhea, and the 
best and most simple mode of treating it. 

It has been generally supposed that this disease was the 
effect of a specific virus, and that it could only be produced 
by contact with one who had the disease. But I had long 
since been convinced that this was not so, and lately sev- 



GONORRHEA. 405 

eral eminent writers who have had large opportunities to 
observe the disease have decided that it can be and often 
is generated by indiscriminate impure cohabitation, and 
even can be produced by the acrid secretions from the 
mucous lining of the vagina in certain forms of inflamma- 
tion of that membrane, making it possible for a man to 
contract the disease from his innocent and virtuous wife. 
It is important that this should be known, as it has often 
happened, several cases having come under my own obser- 
vation in which very serious domestic disturbance has orig- 
inated from this cause. For instance, a man finds himself 
laboring under this disease, and, knowing that he has had 
no opportunity of contracting it but from his wife, he will 
naturally infer that she has been playing false; and what 
will strengthen this belief is that the discharge in leucor- 
rhea, or whites, when there is chronic inflammation of the 
mucous lining of the vagina, does simulate very closely the 
true gonorrheal discharge. But, though it is well to bear 
in mind that gonorrhea may be contracted from a perfectly 
innocent person, yet those cases are rare, and it is always 
safe to presume illicit intercourse when this disease pre- 
sents itself. However originated, when this disease once 
has an existence it becomes contagious, and is in no respect 
different from that which has come down through a long 
disreputable line of succession. 

Gonorrhea usually makes its appearance just inside the 
external orifice of the urethra, which presents a deeper 
redness than ordinarily; at first it only itches, but presently 
a burning sensation is felt on passing water, the inflamed 
mucous membrane being now not in relation to the urine. 
In the male there can now be a drop or two of yellowish 
fluid forced from the urethra by pressing upon the glans 
penis. If neglected and allowed to proceed it travels on- 
ward toward the bladder, but very rarely extends into that 
organ, but usually stops a little more than half-way. The 
burning on passing water becomes more and more intense, 
and the discharge increases in quantity, the organ becomes 
swollen, and the under side, being the most vascular, swells 
the most, and gives it a curved appearance. But some- 



406 INFLAMMATION. 

times the inoculation takes place on the outside of the 
glans penis, under the loose fold of skin called the prepuse, 
and may be easily mistaken for syphilis. It may be distin- 
guished from this disease by there being no chancres — eat- 
ing sores — but the whole surface under the prepuse looks 
raw, and throws off a profuse amount of very filthy-look- 
ing discharge. The virus, like that of syphilis, may be 
absorbed and occasion buboes which can not be distin- 
guished from those produced by pox; they are, however, 
not so liable to suppurate, and are much easier removed by 
resolution. If a person suffering from this disease is not 
very careful he may allow some of the poison to adhere to 
his fingers, and then, by rubbing his eyes, communicate 
the disease to them. Most terrible results are apt to 
follow. 

In the female this is usually quite a trifling disease, and, 
I am disposed to think, is often entirely unobserved, the 
filthy subjects of it nearly always having the whites, and 
this may easily be mistaken for that complaint ; it however 
causes more burning in passing water, and will always show 
inflammation at the orifice of the urethra, which the other 
does not. This much must suffice as to the nature and 
diagnosis of this disease, and we will now give some plain 
directions for its treatment. 

Treatment. — Taken at its inception, while it is confined 
to about an inch of the urethra, it can be arrested at once. 
Procure half an ounce of a ten-grain solution of nitrate of 
silver, and a small glass penis syringe; grasp the organ 
about midway, and press it between the thumb and finger, 
while an assistant throws up some of the medicine; let the 
syringe remain in for a few moments, so as to prevent the 
solution from passing out. This will cause pretty severe 
suffering for a few minutes, but the cure will be perfect, 
and the remedy need be applied but once. Care must be 
taken to press the urethra firm enough to prevent the solu- 
tion from passing into the bladder, as of this strength it 
would do some mischief. But if the disease has continued 
for several days the probability is that the lining of the 
urethra has become affected too far up for this plan to 



GONORRHEA. 407 

succeed, and it must be treated differently. I know of no spe- 
cific for clap; many suppose balsam copaiva to be one, but it 
is certainly a mistake, and I have long since quit giving it, 
as the disease can be just as well managed by less objectionable 
means. I treat it as simple inflammation. Abstain from 
meat and stimulating drinks, take salts and soda in full pur- 
gative doses for a few days, and then only enough to keep 
the blood cool; a small tea-spoonful, dissolved in half a 
glass of water, taken three times a day, is usually sufficient. 
After this treatment has been continued a week, a tea made 
of the uva ursi leaves and the bark of wild cherry may be 
substituted. During the treatment the parts should be 
frequently bathed in cold or tepid water, and every night 
the organ should be wrapped up in a wet towel. 

If there be swelling of the glands in the groin, use any 
good remedies for scattering them ; the best I have seen 
tried is equal parts of tincture of iodine and chloroform 
liniment, and at night apply a poultice made of peach-tree 
leaves and wheat bran. 

If the patient should present the appearance of being 
bilious, that is, if the liver does not do its whole duty, and 
suffers part of the material of which bile is made to remain 
in the blood, indicated by some yellowness of the whites of 
the eye, duskiness of the skin, and a foul tongue, it will be 
w r ell to give a few doses of calomel, or blue pill; and if 
there should be a dry skin, and more thirst than is natural, 
put two grains of tartar emetic into a glass of water, and 
take a swallow occasionally, so as to produce very slight 
nausea, and continue it until the surface becomes moist. 

If the disease should become transferred to the eyes, it 
must be treated actively, or the sight may be lost. Leeches 
should be at once applied, the eyes bathed, almost continu- 
ously, with a decoction of oak bark; and a solution of nitrate 
of silver, ten grains to the ounce, dropped into the eyes two 
or three times every day. When the disease has become 
partially subdued, apply blisters behind the ears, and keep 
them running by dressing them with savin ointment. 

There will be found in the chapter of formulas several 
recipes upon which some of my distinguished medical 



408 INFLAMMATION. 

friends chiefly rely in the treatment of this disease » 
One of the most prominent and successful practitioners 
of my acquaintance, and who does an extensive practice 
in this disease, informed me recently that he had, for 
many years, relied almost exclusively on mild, astrin- 
gent injections for the cure of simple gonorrhea. His 
favorite injection is composed of acetate of lead and 
sulphate of zinc, each two grains, and water one ounce, 
this to be thrown into the urethra three times a day or 
oftener, and keep the parts enveloped in a cold, wet towel. 

Although I have seen many instances of stricture and 
other injuries caused by improper injection, yet I am cer- 
tain that this can do no harm, and if used in conjunction 
with the regimen I have recommended, might hasten and 
insure the cure. 

A very formidable consequence of gonorrhea is an occa- 
sional transfer of the irritation to one of the testicles, (I 
have never seen both involved at once,) causing what is called 
Hernia Humoralis, that is, the nut becomes swollen, hard, 
and exceedingly painful. It is true, this disease sometimes 
arises from other causes, as fatigue, straining, exposure to 
wet and cold, etc.; but the clap is the most common cause 
of it. But however it may originate, it is a most painful 
and dangerous complaint, so far as the manhood of the 
patient is concerned, and should be treated actively at once. 
All the means calculated to subdue ordinary inflammation 
should be resorted to, as leeching, fomentations, poultices, 
cooling purgatives, combined with anodynes, etc. Example : 
leech — nothing can be substituted for this — then envelop it 
in a warm, wet cloth, keep the bites bleeding as long as 
possible, then apply a hop poultice, or a cloth saturated with 
an infusion of bitter herbs, as tansy, catnip, hoarhound, etc.; 
at the same time add a table-spoonful of epsom salts, a tea- 
spoonful of common soda, and a drachm of Dover's powder, 
or a tea-spoonful of laudanum to a common tumbler of 
water, and give a table-spoonful of this every half hour, 
until relief is obtained, then make the intervals longer. 
Another unpleasant consequence of clap, which often hap- 
pens, is stricture of the urethra. I treat this by the use of 



GLEET. 409 

slippery elm bougies. See slippery elm in the chapter on 
formulses. 

If the irritation has extended to the bladder, take creo- 
sote, twelve drops, cinnamon water, two ounces; do_se — a 
tea-spoonful every three hours. Also, bicarb, potasa, one 
drachm, water, eight ounces; dose — a table-spoonful every 
three hours. These remedies will promptly relieve what is 
called gravel in pregnant women. 

GLEET RUNNING AT THE REINS. 

This disease is characterized by a discharge, more or less 
copious, of a milky or glairy fluid from the urethra, attended 
by a sense of weakness and giving away about the loins, is 
discharged involuntarily and nearly without pain or uneasi- 
ness. It is often the sequence of badly cured gonorrhea, 
but is also frequently occasioned by exposure to cold and 
wet, or by excessive sexual intercourse. The treatment 
which has rarely failed in my hands of giving complete re- 
lief is to fill a bottle about half full of equal parts of chip- 
pings of the knots found in pine plank and wild cherry bark, 
and then fill it with good whisky, and take one or two table- 
spoonfuls three times a day. A burgundy pitch plaster 
applied to the loins will assist the cure, as also will mild 
astringent injections into the urethra; an infusion of com- 
mon green tea I prefer to any thing which I have found as 
an injection. 

It can also be cured by drinking daily, for a few weeks, 
a pint of the infusion of uva ursi (barberry) leaves, made 
by pouring a pint of boiling water on two table-spoonfuls 
of the leaves; four or five drops of spirits of turpentine 
dropped on a lump of sugar should, at the same time, be 
taken three times a day. 

The seminal secretion is often combined with the usual 
discharge in gleet, and involuntary and nocturnal emissions 
are frequently mistaken for it; in either case no special 
treatment is necessary. If the patient is suffering from 
general debility and relaxation resort should be had to 
tonics, generous diet, and all the other means calculated to 
improve the tone of the system; or if there be repletion 



410 INFLAMMATION. 

and over action, resort should be had to abstinence from" 
stimulating food and drinks, and broken doses of the saline 
mixture. 

The country has been secretly flooded by the villainous 
circulars of charlatans addressed to young men on seminal 
weakness, etc., by which thousands of good young men 
have been rendered unhappy, and have had their health 
ruined by taking the nostrums prepared by these scoun- 
drels to remove a condition which was neither a disease nor 
the effect of sinful practices, but merely the natural conse- 
quence of continence. I am satisfied that instances of 
self-abuse are much rarer than would be inferred from the 
writings of some of our best authors, and genuine cases of 
seminal weakness are still rarer; when it does exist the 
following pills may be taken : 

R Gum camphor, 20 grains. 

Sul. of morphia, 5 grains. 

Muriate of ammonia, 30 grains. 
Mix ; make 20 pills ; take one every night. 

RHEUMATISM. 

Rheumatism may be divided according to its seat or its 
grade of excitement. Thus, some writers treat of it under 
the heads of articular and muscular rheumatism, the former 
occupying the joints, the latter the muscles ; but the fact is, 
that, though the disease is often situated exclusively in one 
or the other of these parts, it quite as frequently occu- 
pies both, to a greater or less extent, in the same attack. 
A better division is that founded upon difference in grade ; 
and, for convenience of description, the four following 
varieties may be recognized : 1. The acute, in which violent 
local inflammation is attended with considerable constitu- 
tional disturbance, or fever. 2. The subacute, in which the 
inflammation is less violent, and there is little or no fever. 
3. The chronic, which is characterized by long duration, and 
the lowest grade of inflammatory action; and, 4. The nerv- 
ous, in which there is neither inflammation nor fever, the 
disease consisting exclusively in irritation, and that directed 
especially to the nervous tissue. 



RHEUMATISM. 411 



ACUTE RHEUMATISM. 

Symptoms, Course, etc. — Fever invariably attends this 
form of the disease. It is said sometimes to precede the 
inflammation ; but this event is rare. The primary symp- 
toms are generally local. In the great majority of cases, 
they show themselves in the extremities, and usually first 
in the lower. The disease may be confined to a single joint, 
or to a part or the whole of one limb ; but much more fre- 
quently it affects several limbs, and different portions of the 
trunk, jointly or successively ; and occasionally it involves 
almost the whole exterior of the body. It has been ob- 
served, however, that when this last event occurs, one side 
of the body is more severely affected than the other. The 
small joints, as those of the fingers and toes, are less fre- 
quently inflamed than the larger, as the ankle, knee, wrist, 
and elbow. 

Sometimes the complaint begins with a feeling of uneasi- 
ness or stiffness in the part, which soon amounts to soreness 
or positive pain, especially upon motion. In other instances, 
the first symptom is acute and violent pain. Heat and 
swelling soon come on ; and, when the pain has been sharp 
and lancinating, it is very commonly moderated after tume- 
faction. Extreme soreness, however, remains, and the slight- 
est movement of the part occasions suffering. The swelling 
is usually tense and elastic, and the surface often reddened, 
with a light rose-color gradually shading off into that of the 
healthy skin ; but in many instances the natural color is in 
no degree altered. 

Commencing generally in one part, the inflammation 
quickly extends to others, as from the ankle to the knee, or 
from the ankle or knee of one side to the corresponding 
joint on the other; then to the wrist or elbow; sometimes 
in its progress attacking neighboring parts, sometimes dis- 
tant parts in succession, and often declining or disappearing 
in one seat after fixing upon another. The swelling of the 
deserted joint does not immediately subside with the pain, 
but usually becomes softer, and, instead of being firm and 
elastic, will often pit somewhat upon pressure. Not unfre- 



412 INFLAMMATION. 

quently, a joint is attacked a second time, and occasionally 
a third or fourth time, or even more frequently, before the 
disease ends. In some cases, the inflammation is confined 
chiefly to the neighborhood of the joints ; in others, it 
affects more especially the muscles ; in others, again, both 
structures are involved, and, indeed, all the tissues, the whole 
limb being swollen, tense, and extremely tender. In the 
joints, the disease may be confined to the ligaments, or may 
affect also the synovial membrane. In the former case, the 
swelling is firm and elastic, in the latter often somewhat 
soft and fluctuating, in consequence of the increase of the 
synovial secretion. The latter condition is especially ob- 
servable in the knee, where fluctuation may be perceived on 
each side of the patella. The swelling is usually greater in 
the more superficial joints, as the ankle, knee, and elbow, 
than in those more protected by muscles, as the hips and 
shoulders. In severe cases, the suffering is often very great. 
The pains, which are scarcely ever entirely absent, are at 
times almost excruciating, being described as tearing, rend- 
ing, etc., and the slightest movement, or the least jar or 
, pressure, produces so much suffering that the patient does 
not dare to change his position, and dreads the approach of 
any one to his bed. 

Very soon after the local seizure, rigors and other symp- 
toms of commencing fever are experienced, followed by 
increased frequency of pulse, heat of skin, furred tongue, 
loss of appetite, thirst, and occasionally headache. The 
fever is almost always of the inflammatory character, and 
generally of a violence proportionate to that of the local 
affection, though not invariably so. The pulse is full, strong, 
and usually not very frequent, varying from ninety to a 
hundred and ten, and probably in the greater number of 
cases not exceeding a hundred. Respiration is not sensibly 
disturbed while the disease confines itself to external parts. 
The surface, though warm, is less heated than in most othei 
fevers, and is often moist — sometimes, indeed, bathed in 
copious sweats, which have a peculiar sour and sickening 
smell, and have no effect in relieving the inflammation or 
pain. The tongue is usually moist and thickly covered with 



BHEUMATISM. 413 

a whitish fur. There is seldom nausea or vomiting. The 
bowels are generally constipated, and sometimes obstinately 
so. The secretions are little diminished, with the exception 
of the urine, which is scanty, high-colored, and disposed to 
let fall lateritious sediments upon cooling. The brain is 
usually remarkably exempt from disorder, the patient being 
scarcely ever delirious, though not unfrequently deprived of 
sleep by the violence of his pains. The fever is usually 
remittent, with exacerbations in the evening, which are often 
accompanied with an increase of the pains. These are 
consequently worse at night, and relax somewhat with the 
fever in the morning. 

The disease may run its course, and very often does so, 
without penetrating any of the great cavities. But often, 
also, either by a simple extension, or by a metastasis of the 
inflammatory action, various internal organs become affected, 
and the case very seriously complicated. The most frequent 
of these complications is inflammation of the lining and 
investing membranes of the heart, constituting endocarditis 
and pericarditis. The fact that serious organic disease of 
the heart occasionally originates in rheumatism, and even 
the peculiar liability of the cardiac membranes to become 
inflamed, have been long known to the profession; but 
Bouillaud was the first to prove the frequency of the affec- 
tion, and its existence in many cases in which the ordinary 
symptoms would not have indicated it. 

Next to the membranes of the heart, the pleura is pro- 
bably the most frequent seat of internal rheumatic inflam- 
mation. Pleuritis, however, seems, in most cases, to be an 
extension of the cardiac disease, or at least to occur simul- 
taneously with it. The pleurisy of acute rheumatism differs 
apparently in nothing from the disease arising from other 
causes. (See Pleurisy.) 

Sometimes the brain or its investing membranes are 
affected. There is reason to believe that the disease is 
seated more especially in the membranes, though an irrita- 
tion is undoubtedly propagated to the cerebral substance. 

The peritoneum is said to be sometimes, though rarely, 
affected. I do not remember to have witnessed an instance 



414 INFLAMMATION. 

of the kind. Occasionally violent affections of the stomach 
and bowels supervene in rheumatism, but oftener, I believe, 
in other forms of it than in the acute. The same may be 
said in relation to the kidneys. 

A variety of acute rheumatism denominated bilious, is 
quite common in miasmatic districts. Its peculiarities may 
be dependent upon two causes. The transfer or extension 
of rheumatic irritation to the liver may derange the func- 
tions of that organ, giving rise in some instances to bilious 
vomiting from an excess of secretion ; in others, to yellow- 
ness of the tongue, conjunctiva, and skin, with bilious 
urine and clay-colored stools, from a suspension of the 
secretion, as in jaundice. But more frequently, the rheu- 
matism is coincident with an attack of intermittent or 
remittent fever, and exhibits, along with its own peculiar 
phenomena, the bilious symptoms and paroxysmal character 
of those affections. 

The disease occasionally assumes an adynamic character, 
marked by diminished force and increased frequency of 
pulse, copious sweats during sleep, a feeling of great de- 
bility, and a more than ordinary tendency to metastasis. 
The symptoms, however, are seldom or never of that pecu- 
liar kind denominated typhous. 

The duration of acute rheumatism is uncertain. By 
proper remedial measures it may frequently be arrested in 
a week or two ; but sometimes it runs on for six weeks, 
two months, three months, or even longer. Perhaps from 
two to three weeks is the ordinary duration under judicious 
treatment. In its course it not unfrequently exhibits alter- 
nations of amendment and aggravation; and sometimes, 
when every thing promises fairly, the disease resumes, with- 
out obvious cause, all its original violence. In some cases, 
it appears like a succession of local attacks in different 
parts, each running a course of a week or ten days, and not 
unfrequently recurring again and again in the same part. 
In any one position, a decline of the disease is indicated, 
first by the diminution or disappearance of the pain, then 
by a softening of the part, so that, instead of being tense 
and elastic as at first, it will not unfrequently retain for 



RHEUMATISM. 415 

some time the impression of the finger, and, lastly, by a 
gradual subsidence of the swelling. When the general 
disease is about to give way, new accessions of inflamma- 
tion cease, or, if they occur, exhibit a much milder charac- 
ter ; the violence of the pain everywhere subsides ; the 
patient loses his excessive sensibility to impressions from 
without; and the febrile symptoms are moderated or dis- 
appear. Some swelling and soreness are apt to remain for 
a considerable time after the violence of the disease is 
passed ; and weakness and stiffness of the joints and mus- 
cles are frequently left, after convalescence has been long 
established. In some cases, the febrile movement does not 
cease with the obvious inflammation, being kept up proba- 
bly by some lurking affection of the internal organs, possi- 
bly by inflammation of the inner coat of the arteries. On 
the contrary, more or less local disease is not unfrequently 
left after the fever has gone, and the acute degenerates into 
chronic rheumatism. 

Causes. — Almost the only known exciting cause of acute 
rheumatism is cold. Moisture increases its effect, but, in 
all probability, only by serving as a more rapid conductor 
than the dry air. The cold operates most powerfully 
during perspiration, from previous exercise or exposure to 
heat. Sleeping in damp sheets or upon damp ground, the 
wearing of wet clothes, exposure to cold rains without sub- 
sequent change of dress, and sitting in a damp, cold room, 
are examples of the kind of exposure which is apt to be 
followed by the disease. From a knowledge of the cause 
of rheumatism, it would be inferred that the complaint 
must be most prevalent in damp changeable climates, and, 
as relates to the seasons, in the latter part of autumn and 
in spring. 

But something more is requisite than cold. There must 
also be a peculiar state of system predisposing to this form 
of disease. There must be a rheumatic diathesis. In 
what this diathesis consists has not been discovered. There 
are no signs by which its existence can be detected, with 
an approach to certainty. Large-jointed, muscular, and 
lank frames are probably more frequently affected than 
27 



416 INFLAMMATION. 

those of opposite characteristics. Men are more subject to 
the disease than women, but, in all probability, because 
more exposed to vicissitudes of temperature. The predis- 
position is certainly much affected by age. Children under 
ten years, and adults over sixty, are seldom attacked ; and 
the period of life at which the disease is most prevalent is 
probably between fifteen and thirty-five or forty. Among 
the most powerful predisposing causes of the disease is a 
previous attack of it. At least, persons once affected are 
more liable to the disease afterwards than they had previ- 
ously been; and when it occurs in the old, it is almost 
always in those who have been attacked at an earlier period 
of life. I think it is no less certain that a predisposition 
to the disease is often inherited. It is very apt to exist in 
members of the same family, whether inherited or not. 
Debility appears to favor the predisposition; though full 
and vigorous health does not afford protection. The dia- 
thesis, when strong, is alone sufficient to generate the dis- 
ease, without the aid of exciting causes. 

Diagnosis. — Gout is the only disease with which the 
acute rheumatism is liable to be confounded ; and from this 
it is in general readily distinguished. The same, however, 
cannot be said of some other forms of rheumatism. The 
diagnostic symptoms will be more conveniently given under 
the head of gout. 

Prognosis. — Acute rheumatism, though an exceedingly 
painful disease, is in adults very seldom immediately. fatal, 
and, if properly managed, rarely leaves any fatal effects 
behind it. If uncomplicated with the internal inflamma- 
tions alluded to in the account of the symptoms, it may 
almost always be conducted to a favorable issue. Of these 
complications, the cerebral, though comparatively unfre- 
quent, is probably, in proportion to the number of cases in 
which it occurs, most fatal. The dangers to be appre- 
hended from endocarditis and pericarditis have been already 
alluded to. 

SUBACUTE RHEUMATISM. 

Ver}^ many cases of rheumatism occur, so limited in ex- 



RHEUMATISM. 417 

tent, and attended with so little constitutional disturbance, 
as to have no claim to be ranked with the acute variety ; 
while their brief duration excludes them from the chronic. 
These are embraced in the division at present under con- 
sideration. As in the preceding variety, the disease may 
in this, affect either the muscles or the joints ; but, while 
in the acute the joints are most frequently affected, in the 
subacute the precedence belongs to the muscles. 

Symptoms, Course, etc. — Two or more joints may be in- 
flamed ; but, in probably the greater number of instances, 
the disease is confined to one at the same time ; as, with 
the grade of action often present in these cases, an exten- 
sion to several of the articulations simultaneously would 
give rise to decided fever, and thus constitute acute rheu- 
matism. The local symptoms are not materially different 
from those described under the preceding variety. The 
pain, however, is usually less severe, amounting often only 
to slight aching or soreness. There is also less redness and 
heat, and the swelling is less tense and elastic. There is 
sometimes increased secretion of the synovial fluid, and 
that of the bursse, and fluctuation may be noticed in the 
vicinity of the joint, especially the knee. 

In the muscular form, as in the articular, the disease may 
extend to several muscles, or be limited to one. It very 
frequently extends to several in the same neighborhood, 
and concerned in the same office. In some instances, there 
is at first a feeling of soreness, which gradually increases 
until it amounts to a dull aching pain, which becomes acute 
when the muscle contracts. In others, the patient first be- 
comes sensible of the complaint by a very severe sharp 
lancinating pain, which seizes the muscle upon some occa- 
sion when it is suddenly called into action, as upon attempt- 
ing to rise from the sitting posture, to turn in bed, or to 
lift a burden. The pain is sometimes excruciating, so as 
to render the patient unwilling or unable to repeat the mo- 
tion ; and, when the part is necessarily moved, as in respi- 
ration, coughing, etc., the suffering is very great. During 
the intervals of motion, there is generally also a sense of 
uneasiness or aching, with increased heat, and the part is 



418 INFLAMMATION. 

usually more or less tender when pressed. Sometimes 
there is tumefaction ; but it is seldom if ever considerable, 
and is often wanting. The pulse is sometimes excited, and 
the general heat increased ; but the constitutional disturb- 
ance scarcely amounts to fever. Any of the external 
muscles may be affected, and the disease often takes a name 
according to its seat. The internal muscles are also often 
attacked either primarily or secondarily. 

But this variety of rheumatism is not confined to the 
joints and muscles. It is probably capable of attacking 
any of the tissues. There is reason to believe that it some- 
times seizes upon the nervous sheaths, producing pain upon 
pressure along their course, and extending an irritation to 
the nerves themselves, which is felt in pain and spasm of 
the parts to which they are distributed. Many of the 
severe and complicated nervous disorders, both of external 
and internal parts, connected with tenderness of the spinal 
column when the spinous processes are pressed, are proba- 
bly owing to subacute rheumatism in the sheath of the 
spinal marrow. 

This variety of rheumatism is peculiarly liable to metas- 
tasis, certainly more so than either the acute or the chronic. 
In the acute, the inflammation is so severe as to give a 
strong direction of the disordered constitutional tendencies 
to its own seat ; in the chronic, the disease appears often to 
be almost local, and to have no disposition to change. In 
the subacute, the constitutional tendency to rheumatic dis- 
ease is strong, while the local affection is so feeble, that it 
readily yields to causes which give the irritation another 
direction. The variety is intermediate between the high 
inflammatory and the pure nervous forms. 

To complete a view of subacute rheumatism, it will be 
necessary to consider it in some of its more frequent and 
prominent seats. 

In the Scalp. — The subcutaneous muscular and fibrous 
tissue of the scalp is occasionally attacked with this form 
of rheumatism. It is known by headache, often quite 
severe, soreness of the scalp on pressure, and the presence 
of rheumatism previously, or at the same time, in some 



RHEUMATISM. 419 

other part of the body. These symptoms will in general 
suffice to distinguish it from nervous or sick headache, for 
which, without care, it may be readily mistaken. In this 
latter affection, pressure, instead of causing pain, often 
yields relief. 

In the Face. — The masseter muscle is sometimes affected 
with rheumatic inflammation, so that the patient cannot 
open his mouth, and great alarm is sometimes created under 
the apprehension of tetanus or lockjaw. 

In the Neck. — Under the name of stiff-neck, wry-neck, or 
torticollis, rheumatism sometimes exists in the muscles of 
the side of the neck. It may occupy both sides of the 
neck equally, in which case the head is held stiffly erect, 
and steadily looking forward ; but much more frequently 
one side only is disordered, and the head is drawn towards 
that side, usually more or less obliquely. While the head 
is allowed to remain at rest, the patient is easy, or feels 
only a dull aching; but every movement is exquisitely 
painful. 

In the Parietes of the Chest — Pleurodynia. — This com- 
plaint is not unfrequent. It is a rheumatic affection of the 
intercostals or muscles between the ribs, and other muscles 
of the trunk, and is characterized by severe, acute, and 
generally shifting pain in the side upon taking a full breath 
or coughing, by soreness of the intercostal spaces upon pres- 
sure, and by the general absence of fever. It resembles 
pleurisy considerably in its most obvious symptoms, and 
when attended, as sometimes happens, by a slight febrile 
movement, or by an accidental cough, the diagnosis is so 
uncertain, that it can be made out only by attending to the 
physical signs. (See Pleurisy^ The risk of confounding 
the two affections is increased by the fact that, in conse- 
quence of the pain arising from the movement of the inter- 
costal muscles, there is little expansion of the affected side 
of the chest, so that the respiratory murmur is less distinct, 
and percussion somewhat duller, than in health. As other 
muscles about the chest are often affected at the same time, 
the diagnosis is sometimes aided by the occurrence of severe 
pain upon attempting to twist or bend the trunk. 



420 INFLAMMATION. 

In the Abdominal Parietes. — This is a very rare seat of 
rheumatism, which nevertheless does sometimes attack the 
abdominal muscles, producing symptoms that might be mis- 
taken -for those of peritonitis, though distinguishable by the 
effect of movement, and the want of the constitutional 
symptoms of the former. 

In the Lumbar Muscles — Lumbago. — This occupies the 
muscles situated .in the small of the back, sometimes extend- 
ing up the spine, sometimes shooting round toward the 
abdomen. It maybe upon one side exclusively, or upon 
both. It is often first recognized by the occurrence of a 
sharp pain, as if from the thrust of a knife, upon attempt- 
ing to rise from the sitting posture, or to raise a burden. 
When, very severe, it confines the patient to bed, and in one 
position, from which he cannot move without exquisite 
suffering. In milder cases the patient can often walk, but 
always stiffly, and generally partially bent forward upon the 
hips, with the spine perfectly rigid. It is not unfrequently 
attended with more or less febrile action, and may even be 
so severe and extensive as to come, with great propriety, 
under the division of acute rheumatism. In such a case, 
however, it usually forms a part of a more extensive affec- 
tion. The effects of motion, and the tenderness on pressure, 
sufficiently distinguish it from the violent pains of malignant 
fevers. From inflammation of the kidneys it differs in 
wanting the peculiar direction of the pain towards the 
groin, the retraction of the testicles, the irritation of the 
urinary passages, and the nausea and vomiting which char- 
acterize that disease ; as also in the more decided tender- 
ness, and greater pain on certain motions which bring the 
muscles of the back into play. Disease of the spine occa- 
sions also severe lumbar pains, which are sometimes in- 
creased by motion; but there is less pain upon pressure, 
less acuteness in the symptoms, and more or less disorder 
in the functions of the lower extremities, which is wanting 
in lumbago. 

In the Hip — Sciatica. — The parts about the hip are often 
attacked with rheumatism, which is seated sometimes in the 
muscles, sometimes in the joint or in the ligaments of the 



RHEUMATISM. 421 

pelvis, and occasionally, also, there is reason to believe, in 
the neurilemma of the sciatic nerve, showing itself by ten- 
derness along the course of that nerve, and pain, with other 
disordered sensations, in the corresponding thigh and leg. 
The simultaneous occurrence or previous existence of rheu- 
matism in other parts, is the surest diagnostic sign of this 
affection, which might otherwise be readily confounded with 
neuralgic pains, or those having their origin in common in- 
flammation. The steadiness of the pain, which is rather 
dull than acute, and its increase when the patient becomes 
warm in bed, are other signs of its rheumatic character. 
Sciatica, however, is more frequently chronic than either 
acute or subacute. 

In the Heart. — The subacute form of rheumatism is pecu- 
liarly apt to invade the internal parts of the body. I 
believe that it is more frequently the origin of serious or- 
ganic disease of the heart than the acute variety. 

In the Alimentary Canal. — Instances of subacute rheu- 
matism in the oesophagus sometimes occur, attended with a 
feeling of constriction, and severe pain in swallowing, but 
they are rare. In the stomach it is not uncommon, pro- 
ducing, according as it attacks the muscular or mucous coat, 
severe pain, with a sense of constriction, and great tender- 
ness on pressure, or a sense of heat, weight, and oppression, 
with nausea and vomiting ; and sometimes the two sets of 
symptoms are combined. Another not unfrequent seat of 
rheumatism, not sufficiently noticed, I think, by authors 
generally, is the muscular coat of the bowels. The patient 
complains of a constant aching in some portion of the 
bowel, especially of the ascending or descending colon, 
which is increased at times into the most violent pain, when- 
ever the muscular coat is stimulated into contraction by the 
contents of the bowels, or the action of purgative medicine. 
Sometimes the muscle is so severely affected that it ceases 
to be able to contract, and obstinate constipation ensues. 
There is generally tenderness on pressure, within a limited 
portion of the abdomen. The disease may often be recog- 
nized from occurring upon the retrocession of an external 



422 INFLAMMATION. 

attack, or in individuals who are known to be subject to 
rheumatism. It differs from colic in being less decidedly 
spasmodic, and from ordinary inflammation of the whole 
thickness of the bowel, in the much less violence of the 
constitutional disturbance. 

In the Diaphragm. — Rheumatism sometimes attacks the 
diaphragm; and there is probably no seat in which it is 
more painful and distressing. A severe pain shoots from 
the epigastrium to the spine, sometimes through the body, 
sometimes circularly along the edge of the ribs, which, in 
violent cases, is increased to agony by every attempt to 
take a full inspiration. Breathing, which is performed 
chiefly by the ribs, is often very difficult and oppressed, and 
sometimes attended with feelings of suffocation. The swal- 
lowing of food produces acute pain at the point where the 
oesophagus penetrates the diaphragm, and sometimes the 
food is rejected in consequence of the spasm thus excited. 
In some instances, only a portion of the muscle 'is affected, 
and the pain may be confined to one side. 

The duration of subacute rheumatism is exceedingly un- 
certain, and depends greatly upon the treatment. It is 
often relieved in two or three days, and sometimes runs on 
for weeks or months, if neglected. In the latter case, how- 
ever, it degenerates into the chronic form. Though much 
more readily subdued than the acute, it is much more liable 
to return quickly. 

Causes. — The causes are the same as those of the acute 
variety. The complaint is very apt to result from a partial 
exposure to cold, as from small currents of cold air, or the 
uncovering, in a cold place, of a part of the body usually 
protected. It is said that sudden muscular movements, or 
violent straining, are apt to induce the disease. They pro- 
bably do so sometimes when a predisposition to it exists ; 
but, more frequently, when supposed to be the cause, they 
are merely the means by which the existence of the disease 
is first made known to the patient. When the constitutional 
tendency is very strong, it is probable that any thing of an 
excitant character may serve to bring on the local affection, 



RHEUMATISM. 423 

such as stimulant drinks, or heating articles of food. Some 
individuals have a peculiar predisposition to this form of 
rheumatism. 

Diagnosis. — The suddenness of the attack, the severity 
of the local compared with the general symptoms, the sharp- 
ness of the pain upon movement when the muscles are con- 
cerned, the frequent shifting of the affection, and the utter 
absence of any tendency to suppuration, are characters by 
which subacute rheumatic inflammation may be distinguished 
from common inflammation occupying the same parts. 

Prognosis. — This is rarely otherwise than favorable. The 
disease is very rarely fatal, unless when it seizes upon 
some vital organ, as the stomach, brain, or heart ; and even 
then may very generally be relieved by appropriate reme- 
dies. The greatest danger is probably a sudden seizure of 
the muscular structure of the heart, so as to arrest its move- 
ments. Another danger is the production of chronic en- 
largement of that organ. 

CHRONIC RHEUMATISM. 

This variety of rheumatism may exist in the fibrous, 
synovial, or muscular tissues, but is most frequent in the 
joints. It may occur either as an original affection, or as 
the consequence of an acute or subacute attack. It is some- 
times limited to a single part, sometimes extends to several ; 
and may be either fixed or movable. Generally speaking, 
however, it is more apt to be fixed firmly in its original seat 
than either of the other varieties. 

In relation to the joints, the swelling is generally not 
great, sometimes scarcely if at all visible, unless the syno- 
vial membrane is affected, when there is often tumefaction 
from the effused fluid. In old cases, however, the ligaments 
are often thickened, and there is not unfrequently some effu- 
sion into the cellular tissue. Redness is generally quite 
wanting. There is, in almost all cases, more or less pain, 
which is obtuse and aching rather than acute, is often in- 
creased by the warmth of the bed at night, and is usually 
worst in damp, chilly weather. Rheumatic patients can 
frequently foretell a storm from the pains produced by 



424 INFLAMMATION. 

the damp, cold winds that precede it. In some instances, 
however, there is little pain, but only a feeling of stiffness 
and weakness upon motion. The heat of the part is seldom 
increased. On the contrary, the patient often complains of 
chilly sensations, and these are sometimes the most unpleas- 
ant local effects of the disease. 

When the muscles are affected, they often waste away, 
shrink, and become shortened. 

In obstinate and very old cases, there is often stiffness or 
immobility of the joints, arising from contraction, thicken- 
ing, and rigidity of the ligaments, and also, in some in- 
stances, from firm contraction or shortening of the muscles 
and tendons. The joints are often distorted by the same 
causes, especially the joints of the hand, in which the fin- 
gers are bent to one side, or abnormally extended or flexed ; 
and it has been observed that the deformity of the one side 
corresponds singularly with that of the other in shape and 
direction. Not unfrequently, in cases of long standing, the 
muscles affected become almost powerless, or even quite 
paralyzed. 

The disease may generally be relieved or cured for a time, 
but is exceedingly apt to return. Sometimes it perseveres 
steadily, in spite of remedies, rendering the life of the pa- 
tient miserable, and wearing him out at last by the incessant 
pains. In some instances, too, suppuration takes place in 
the joints, the synovial membrane ulcerates, the cartilages 
are absorbed, abscesses form in the soft parts and discharge 
externally, and the patient is at last worn out by hectic 
fever, or the denuded ends of the bone granulate and unite, 
forming a stiff joint. 

The duration of chronic rheumatism is altogether irre- 
gular. It may continue for months, years, or a lifetime. 
Many persons affected with it have intervals of comparative 
comfort, recovering their health more or less completely 
during summer, to relapse again in winter, or varying with 
the condition of the weather, to the changes of which they 
become exceedingly sensitive, so as frequently to anticipate 
them before they are obvious to others. 

The causes of this form of rheumatism are the same as of 



RHEUMATISM. 425 

the acute ; but the predisposition to it is not strongest in 
the same individuals. Age has great influence in this 
respect. The old are peculiarly liable to chronic rheu- 
matism, though seldom attacked by the acute. 

The complaints with which it may be confounded are 
common and scrofulous inflammation, and sometimes possibly 
paralysis of certain muscles. From the former it may be 
distinguished by its occurrence in individuals known to be 
rheumatic, its frequently shifting character, especially in 
the earlier stages, the absence of any tendency to suppura- 
tion, the sense of coldness which sometimes attends it, and 
its aggravation by wet damp weather, and by the warmth 
of the bed. A muscle may be deprived of the power of 
motion by rheumatism or by palsy, but the march of the 
disease is so different that, if proper investigation be made, 
there can be little difficulty in forming a correct decision. 

NERVOUS RHEUMATISM. 

Rheumatism very often assumes the form of irritation, 
without the least sign of inflammatory action. It may be 
directed especially to the nervous system, evincing itself by 
pain, or other disordered sensation, and by irregularities of 
the motive-power ; or it may affect any other portion of the 
body, or any one of the organs, producing derangement of 
function in the part or organ affected. The question may 
perhaps be asked, How can it, under these circumstances, be 
known to be rheumatism? The answer simply is, that 
these irritations often alternate with, supersede, or are 
superseded by inflammatory attacks of rheumatism, with- 
out the operation of any discoverable additional cause. A 
patient will be attacked with a neuralgic pain in the face, 
dyspeptic sensations in the stomach, or colicky pains in the 
bowels, which will instantly cease upon the occurrence of 
an attack of subacute rheumatism in one of the joints or 
muscles, and return upon the retrocession of the latter affec- 
tion. It is scarcely possible to resist the conclusion, that 
the same peculiar state of system, the same predisposition 
or diathesis, lies at the foundation of both these modes of 



426 INFLAMMATION. 

derangement, which are, in fact, nothing more than the 
expressions of the real disease, the essence of which 
escapes our notice. 

To give a very general idea of these derangements, it is 
sufficient here to state, that rheumatic irritation may assume 
the form of neuralgic pains in any part of the body ; of 
vertigo, dizziness, headache, tinnitus aurium, [ringing in the 
ears,] perverted vision, etc., when it affects the brain; of 
hurried or irregular breathing, and even violent dyspnoea, 
in the respiratory apparatus; of palpitations, oppression, 
and great precordial distress, in the heart ; of dyspeptic 
sensations, nausea or vomiting, spasm, etc., in the stomach ; 
of colicky pains in the bowels ; and of painful sensation, 
and perverted function in the liver, kidneys, and genera- 
tive organs. 

The exciting causes of this variety of rheumatism are 
the same as of the others ; but there is a different condi- 
tion of system in the individuals subject to it, which 
determines this rather than the inflammatory forms. A 
predominance of the nervous temperament, sedentary habits, 
abstemious modes of living, and, generally, whatever tends 
to depress the powers of the system at large, may be con- 
sidered as favoring the production of nervous rheumatism. 
Hence, it is most frequent in females, students, and pro- 
fessional men, especially those of temperate lives. 

Though a painful, sometimes alarming, and in many 
instances a most harassing disease, it is not often really 
dangerous; and persons subject to it often live to an 
advanced age, and occasionally, after passing the prime of 
life, find the tendency to it to diminish or cease altogether. 
It is true that it sometimes seizes upon the heart, brain, 
lungs, or stomach with fatal violence ; but these cases are 
rare ; and when death occurs in the course of the disease, it 
is much more frequently from the supervention of some 
organic affection, than from the simple uncomplicated irrita- 
tion. 

Nature of Rheumatism. — Having taken a view of the 
different forms of rheumatism, we are now prepared to con- 



RHEUMATISM. 427 

sider its nature. The opinion was at one time prevalent, 
that this disease was dependent on a peculiar offending 
matter pervading the system. 

Another notion is, that the disease is nothing more than 
ordinary inflammation, owing any peculiarities which it may 
exhibit to the tissue in which it is seated. But the truth 
is, that the disease is not necessarily inflammatory. It is 
often purely nervous, and no explanation of its nature is 
admissible which does not take this fact into consideration. 
Besides, ordinary inflammation, occupying precisely the 
same parts, presents different phenomena. 

All that we know of the real nature of the disease is, that 
it is peculiar, and that it owes this peculiarity not to the 
character of the cause, but to some unexplained condition 
of the system, called the rheumatic predisposition or 
diathesis. I am inclined to the opinion that this diathesis 
is in itself a morbid state — in fact, the true disease, and that 
the irritation and inflammation by which it is recognized 
are merely symptoms of its full development. That the 
rheumatic differs essentially from ordinary inflammation is 
shown chiefly by its shifting character, its disposition to 
alternate with mere irritation or functional disorder, and 
the almost entire absence of any tendency to suppuration, 
even in the most violent cases. 

Treatment. — As rheumatism is inflammation, modified, it 
is true, by the peculiar condition of the system consti- 
tuting the rheumatic tendency or diathesis, but yet essen- 
tially inflammation, it follows that it should be treated 
according to the fixed principles which govern us in the 
management of inflammation in general, modified, as far as 
can be, to suit this particular variety of the disease. 

In acute rheumatism, the pulse being usually full and 
strong, and the fever considerable, there is quite a 
unanimity among authors in recommending the antiphlo- 
gistic treatment, consisting, as you have already learned, of 
active bleeding, purging, etc. ; but as this treatment has 
been shown not to be the best in other inflammatory dis- 
eases, it is unnecessary to go into an argument to prove that 
it is not the best in this \ especially as even Wood admits 



428 INFLAMMATION. 

that bleeding won't cure the disease, or even often shorten 
its course, and that patients do not bear up under depletion 
as well in rheumatism as they do in other inflammatory 
diseases of the same apparent grade of action ; and Tanner 
says : " Venesection will merely give temporary relief at the 
expense of future suffering ; it increases the irritability of 
the heart, and consequently predisposes to rheumatic 
inflammation of this organ ; I should as a rule never resort 
to it. That which I believe to be the best treatment con- 
sists in the use of sudorifics, opiates, and saline purgatives." 
Three objects should be had in view in the treatment of 
acute rheumatism — to relieve the pain, lessen the local 
excitement, and to remove the febrile condition. The first 
will be best accomplished by the use of opium, or its pre- 
parations ; the second by sedative and cooling or emollient 
local applications ; and the third by the fever syrup. My 
usual plan of proceeding is, to first give a pretty full dose 
of calomel — say ten or fifteen grains — and follow it in a 
few hours with epsom salts, so as to obtain a thorough 
operation from the bowels, and clear them of all offending 
matter. While this is being done, I order the inflamed 
part to be enveloped in flannel, saturated with an infusion 
of some of the bitter herbs, or mullen leaves, which I think 
preferable ; the chloroform liniment may also be applied at 
the same time, by sprinkling it on the side of the cloth 
which is applied next to the inflamed surface each time it is 
renewed, which should be often. As soon as the bowels 
are freely evacuated, I administer a full dose of opium and 
quinine, viz.: two grains of opium, or one of morphine, and 
ten grains of sulphate of quinine ; and direct a tablespoon- 
ful of the fever syrup to be given every two or three hours, 
but not to awaken the patient to give it : " if he sleeps, he 
will do well." As a general rule, I never allow my patients 
to be awakened out of a natural sleep to take medicine. It 
is best to time the remedies so that the opiate may be taken 
near the usual hour of going to sleep. ' After the first dose 
I rarely repeat the calomel, but order daily as much salts 
as will insure two or three discharges from the bowels. 
An equal quantity of epsom salts and cream of tartar often 



RHEUMATISM. 429 

answers better than the salts alone, and is more pleasant to 
take. After the inflammation is pretty well removed, if 
there remain any hardness, I order the part to be painted 
well, twice a day, with the tincture of iodine, and the 
poultice still continued. 

If the disease be what has been described as subacute, 
instead of the active purgatives recommended above, I 
usually prescribe the following pill : blue-mass, comp. ext. 
of colocynth, and castile soap, each twenty grains ; make 
twelve pills, and give three every night. The syrup should 
be given as before directed, and opium, or Dover's powder, 
sufficient to allay suffering and insure sleep. But bathing 
the whole surface, or even sponging it, with mustard water 
as hot as it can be borne, and then applying the chloroform 
liniment all along the spine and to the part that is suffering, 
will generally give more ease and secure a quieter night's 
rest than can be obtained by the use of opiates ; and then 
the disadvantage of the constipating effects of that drug 
will not have to be obviated by additional purgatives ; but 
in bad cases this may be given, and the other not left 
undone. 

But should this, or the acute rheumatism, assume the 
chronic form, or if the case has been chronic from the 
beginning, it must be treated somewhat differently. Purga- 
tives will only be called for to obviate costiveness, and one 
of the above pills at night, and a teaspoonful of salts in the 
morning, will usually be sufficient. The general condition 
of the system appears to be pretty much the same in 
chronic rheumatism as in scrofula, and may be removed by 
the same remedies. Nothing has succeeded in our hands 
so uniformly as the alterative syrup recommended under 
that head, to which the reader is referred. Much may also 
be accomplished by local appliances. The part should be 
enveloped with flannel, and bathed frequently with some 
highly stimulating liniment : it is best to change the appli- 
cations frequently, as any one will lose its effect by frequent 
repetition. The reader may select from the following, or 
use them in succession : chloroform liniment ; volatile lini- 
ment, made with equal parts of alcoholic spirits of camphor, 



430 INFLAMMATION. 

aqua ammonia, and olive oil ; spirits of turpentine and tinc- 
ture of capsicum, equal parts ; spring oil, or oil of spike, and 
spirits of hartshorn, equal parts ; or, if the parts are cold 
and insensible, oil of pennyroyal, oil of sassafras, and oil of 
juniper, each one ounce, and aqua ammonia, three ounces ; 
this is a powerful application, and should it cause too much 
burning, sweet oil may be added. The patient must avoid 
exposure to cold and wet, or no treatment will prove 
successful; as much exercise should be taken in fine weather 
as can be borne without occasioning considerable suffering. 

The treatment of nervous rheumatism yet remains to be 
given ; and we approach the subject with reluctance, as we 
have been almost a martyr to this disease for forty years, 
and have never found a cure yet. Still, much may be done 
by way of temporary relief, and even procuring weeks or 
months of comparative freedom from the disease ; but our 
observations and experience teach that the disease, after 
having once been set up in the system, is never wholly re- 
moved, but will return from time to time under the most 
judicious management. Every measure which tends to 
invigorate the system, and increase muscular power, and 
lessen nervous irritability, will be found advantageous in this 
disease ; hence, the patient should take much out-door 
exercise in good weather, but avoid exposures and exhaust- 
ing fatigue ; should observe regular hours of eating and 
sleeping — being out at night and losing sleep always in- 
creases our suffering ; the cold bath, or sponging daily the whole 
surface with cold water, is highly useful ; medicines won't 
do much good. I never found them of advantage in my 
own case. Opiates, it is true, will give present ease, but 
their frequent use will injure the general health ; and then 
they soon lose their effect by repetition. Much temporary 
ease can be obtained by the use of the liniments prescribed 
under the last head, or by the use of the flesh-brush perse- 
veringly applied. 

But those who are doomed to suffer from this disease may 
have the consolation of knowing that it rarely leads to fatal 
results, or wholly disqualifies the patient from the pur- 
suit of business, or even pleasure; and, I have thought, 



GOUT. 431 

serves as a kind of safety-valve, by which excessive nerv- 
ous excitement often expends itself, and prevents the de- 
velopment of forms of disease more dangerous, if not more 
annoying than it. 

GOUT. 

This disease is very seldom met with in its true form in 
this country; in fact, I have never yet been consulted in a 
case presenting all the characteristics of a genuine fit of the 
gout as described by English authors. In this country ne- 
cessity or custom almost forces every man to engage in 
some form of business requiring a sufficient outlay of mus- 
cular and nervous power to ward off the development of 
this disease as it is often met with among the English aris- 
tocracy, who often, besides inheriting a predisposition to 
the disease, enjoy the means for indulging in idleness and 
high living calculated to develop the predisposition into act- 
ive disease. But even in this country, where every man, 
whether rich or poor, is forced by custom or the force of 
circumstances to exert his muscular as well as mental en- 
ergies, we often meet with forms of subacute rheumatism 
partaking, more or less, of the gouty character. But they 
are amenable to the same treatment found to succeed best 
in uncomplicated rheumatism, except that the use of iodide 
of potash is imperatively demanded. In all cases present- 
ing gouty symptoms — namely, painful swellings of the 
small joints, with dyspeptic symptoms — the proper course 
will be light but nutritious diet, abstinence from all fer- 
mented and alcoholic stimulants, active out-door exercise in 
good weather; anodyne stimulants applied locally, such as 
chloroform liniment, spirits of camphor and laudanum, etc. ; 
and, internally, iodide of potash, one ounce; water, one 
quart; take a table-spoonful after each meal, and as many 
pills made of castile soap, taken daily, as will give one or 
two motions from the bowels daily. 
28 



432 FUNCTIONAL DERANGEMENTS. 



FUNCTIONAL DERANGEMENTS. 



A multitude of ills " that flesh is heir to," many of which 
are sufficiently grave to destroy life, consist wholly of de- 
rangement of functions ; are not necessarily connected with 
fever, or inflammation, or structural change, but are simply 
departures from healthy action, so that if death takes place, 
dissection will reveal no evidence of permanent alterations 
in the parts most implicated that would account for the fatal 
result. 

In treating of this class of diseases, we are necessarily 
thrown back upon first principles, and will have to revert to 
those laid down in the fore-part of this work, It is there 
stated that disease consists in a broken balance in the move- 
ments of the machinery of life ; that while harmony of 
action is maintained, there cannot be disease ; if the move- 
ments be vigorous, there will be high developments of the 
phenomena of life, and if they be feeble, that low or weak 
developments of life will be manifested; but if there be 
harmony of action, no disease will or can be present; that 
the first condition merely results in the enjoyment of the 
zest of high-toned, vigorous existence, and the latter in a 
low or feeble enjoyment of life, but not connected with 
suffering — not even with a sense of weakness or want of 
vital energy : the zoophyte, which all its life is fastened to 
the rock, and receives its nourishment by imbibition, uncon- 
scious that any other of its species exists ; or the barnacle, 
which fastens itself to the man-of-war, and only changes 
locality by the movements of the stately ship, is perfect in 
its kind, and though its enjoyments must be few, yet its 
sufferings are equally small, and, in its natural low degree 



FUNCTIONAL DERANGEMENTS. 433 

of vital manifestations, it is no more diseased than is the 
captain of the noble steamer and busy crew, who, in the 
enjoyment of young and vigorous manhood, and excited by 
his position, won by deeds of worth, feels life's current flow 
vigorously, and enjoys a zest of life of the highest order of 
which Grod has made his noblest work capable of enjoying. 
There must be a broken balance, a want of harmony, to 
constitute disease ; some parts of the machinery must run 
too fast, while others run too slow, and a loss of harmony 
of movement produced, which must necessarily result in the 
grating of cogs, or the casting off of bands, causing the whole 
machinery to run irregularly, or cease to run. 

Functional disease, then, consists in an altered movement, 
by which the various processes or functions necessary to 
the well-being of the animal economy are imperfectly carried 
on, or performed in excess, or performed with difficulty and 
imperfectly. Now, we have seen that though the manifesta- 
tions of vital action are manifold, and the results various, 
yet all proceed from the same motive-power, and are pro- 
duced by the exercise of a few simple structures, widely 
distributed and variously combined, so as to produce appa- 
rently very different organizations, and present very diverse 
phenomena. The great motive-power resides in the brain 
and other nervous centres ; the nerves are the wires or 
tubes through which they operate, and the messengers which 
convey orders and return intelligence ; the capillaries are 
the workers that do all the drudgery, and are also the fine 
artificers ; and the blood furnishes the material upon which 
they operate. Now, if the power be deficient, or be irregu- 
larly transmitted, or if the operatives are languid and feeble, 
and unable to perform well their task, or if the material be 
deficient, in either case the work will be improperly or 
deficiently done — it will be over-done, or under-done, or not 
done well. 

The great principles, therefore, which lie at the founda- 
tion of all diseased or pathological action are few, and come 
within the comprehension of all who possess mind enough 
to comprehend simple causes and effects. Now, as the 
principles which govern diseased action are few, it follows 



434 FUNCTIONAL DERANGEMENTS. 

that the means by which disease may be cured, or morbid 
action corrected, need not be numerous ; and hence, a few 
remedies fitly chosen may be made to accomplish numerous 
results ; which serves as a sufficient apology for so often 
bringing forward the same means for the treatment of 
different diseases, and for correcting departures from healthy 
action resulting in apparently very different conditions of 
the system. . 

We will now proceed to the consideration of functional 
diseases ; which will be most conveniently classed with the 
organs or structures in which they are manifested. 



DYSPEPSIA. 435 



CHAPTER I. 

FUNCTIONAL DERANGEMENTS IN THE DIGESTIVE OR CHYLOPOETIC 

ORGANS. 

Under the above head will be arranged all functional de- 
rangements connected with the processes through which 
the morsel passes, from the time it enters the mouth, until 
digestion is completed and the debris cast off; including 
mastication, deglutition, digestion proper, lacteal absorption, 
and defecation; involving principally the salivary glands, 
oesophagus or throat, the stomach and bowels, liver, spleen, 
and pancreas, and the lacteal absorbents. But as nearly 
all the functional derangements to which these organs are 
subject are grouped together, or found occasionally in con- 
nection with the very complicated disease known as dys- 
pepsia, the history and treatment of this will almost super- 
sede a necessity for a separate consideration of each or any 
derangement of the separate organs concerned in digestion. 
We will therefore first treat of 

DYSPEPSIA. 

Dyspepsia, or indigestion, is one of the most common 
diseases we have to treat. Any thing which interferes with 
the healthy action of the stomach will give rise to it. 

Causes. — The most frequent cause of dyspepsia is the 
use of food in too large a quantity, or of an improper na- 
ture; or the imperfect mastication of food. Want of exer- 
cise, excessive labor, mental anxiety, general debility, and 
disease of the stomach, liver, or pancreas, will also give rise 
to it. So, when the blood is rendered impure from any 
morbid poison in the system, as that of fever, cholera, etc., 



436 FUNCTIONAL DEEANGEMENTS. 

we have indigestion. It is common in Bright's disease, 
when the blood is contaminated with retained urea, owing 
to the imperfect action of the kidneys. Dr. Beaumont 
clearly proved, in his well-known experiments on Alexis 
St. Martin, that spirituous liquors were most injurious to 
the stomach ; hence, persons in the habit of using them 
often suffer from indigestion. Another common cause is 
an error frequently committed, of not allowing a sufficient 
interval between the meals, to permit of the stomach doing 
its work and resting : for Ab erne thy 's rule, that six hours 
at least should intervene between each meal, cannot be long 
broken with impunity. 

Symptoms. — The symptoms vary, but the most constant 
are, anorexia or loss of appetite ; a sensation of pain, weight, 
and fulness at the epigastrium; flatulence, or the undue 
collection of gas in the intestinal canal ; nausea and vomit- 
ing ; costiveness ; furred tongue ; foulness of breath ; pal- 
pitation of the heart ; pain in the loins ; aching of the 
limbs ; dull headache ; and hypochondriasis. Occasionally 
the patient complains of cardialgia, or heart-burn ; or of 
gastrodynia, or cramp in the stomach ; or of the frequent 
eructation of a thin, watery, acid, or tasteless fluid, consti- 
tuting what is termed pyrosis, or the waterbrash. Pyrosis 
occurs more frequently in women than men, is not uncom- 
mon in advanced life, and often exists in connection with 
some derangement of the nervous system, or — in some in- 
stances — with organic disease of the stomach, pancreas, or 
liver. 

There is seldom a healthy feeling of hunger in this disease, 
but, in place of this, the patient very commonly experiences 
a sensation of hollowness or sinking at the epigastrium, 
when the stomach is empty, which leads him to wish for 
food. Thirst is not unfrequent. 

Eructations of wind, and regurgitation into the mouth 
of food or chyme, or of a sour, bitter, acrid, oily, or offen- 
sive liquid, are common symptoms. 

The phenomena hitherto mentioned belong more espe- 
cially to the stomach. There are also very numerous 
symptoms, having their seat elsewhere, which depend on 



DYSPEPSIA. 437 

derangements either consequent upon those of the stomach, 
or produced by an extended operation of the same cause. 
Among these are various disordered sensations, such as 
headache, giddiness, and heaviness of the head ; muscse 
volitantes, and other results of perverted vision; tinnitus 
aurium, and other unreal sounds, (see Sick-Headache ;) 
irregular pains between the shoulders, in the back, and 
various other parts of the body; a feeling of coldness be- 
tween the shoulders ; stricture, or uneasiness about the 
throat ; and irritation in the larynx and fauces, leading to 
frequent attempts to clear the throat, which at length be- 
come habitual. There is often also general uneasiness or 
malaise, a tendency to low spirits, a feeling of indifference 
or of anxiety and apprehensiveness, an indisposition to 
exertion, irritability of temper, fretfulness, etc. The 
patient is apt to imagine himself affected with consumption, 
organic disease of the heart, or some other incurable malady. 
Palpitations of the heart, coming on at uncertain intervals, 
dyspnoea, and a short dry cough, are not unfrequent symp- 
toms, and tend to confirm these melancholy impressions. 
The patient in general sleeps badly, is disturbed by un- 
pleasant dreams, sometimes by nightmare, and awakes 
unrefreshed, and much depressed in mind. Sometimes, 
however, the sleep is sound, and affords almost the only 
interval of ease. The tongue is usually somewhat furred, 
especially in the mornings, and there is often an unpleasant 
taste in the mouth, as if the saliva were sour. In some 
cases, there is frequent hawking, with a discharge of frothy 
mucus from the fauces. 

The bowels are .almost always constipated, unless in 
cases complicated with chronic enteritis, or excessive secre- 
tion of bile. The hepatic function is also frequently de- 
ranged. The secretion of bile is very often diminished, 
giving rise to light, clay-colored, whitish, or hard and scanty 
stools. Sometimes it is perverted, giving a dark or black 
color to the passages, and more rarely is too abundant, pro- 
ducing vomiting of bile or bilious diarrhoea. 

The surface is usually dry, and of irregular temperature. 
The feet and hands are obstinately cold, but sometimes hot 



438 FUNCTIONAL DERANGEMENTS. 

and even burning, especially at night. In debilitated cases, 
instead of dryness of skin, there is sometimes copious 
sweating. The urine is variously affected, sometimes scanty 
and high-colored, depositing a lateritious or whitish precipi- 
tate, sometimes copious, limpid, and almost colorless. The 
pulse is in some cases quite natural, in others more or less 
disordered, being either too slow or too frequent, or alto- 
gether irregular. In some patients it is very irritable ; be- 
ing slow and regular under ordinary circumstances, but 
thrown into great disorder by slight causes of excitement, 
whether bodily or mental. In such persons, it is apt to be 
rendered very frequent by exertion in the morning. 

The symptoms above enumerated are by no means all 
present in every case. They are combined in almost infi- 
nite diversity; and there are scarcely two cases in which 
striking differences might not be observed. At first, the 
disease usually exhibits itself in slight paroxysms, with 
intervals of almost entire exemption. These attacks are 
little noticed, and gradually increase in duration and fre- 
quency, until at length the patient is seldom without some 
evidences of the disease. 

The patient usually loses flesh, and sometimes becomes 
much emaciated, with flabby muscles, a sunken abdomen, 
a pale, sallow skin, and an anxious expression of counte- 
nance. The disease, however, seldom proves directly fatal. 
In the vast majority of cases, the patient either recovers 
entirely, or so far as to be liable only to occasional returns, 
upon a renewed application of the cause. In others, the 
disorder, which was at first purely functional, becomes 
organic ; chronic gastritis is established ; and the patient 
sometimes sinks under the combined influence of debility 
and irritation. The chief danger from dyspepsia, however, 
is, that the reduced strength of the system may disable it 
from surmounting other diseases by which it may be as- 
sailed. It is possible that, as maintained by Wilson Philip, 
functional sympathetic affections of the liver, lungs, etc., 
having their origin in dyspepsia, may become organic dis- 
eases, and constitute the chief source of inconvenience and 
danger ; but my observation would lead me to the conclu- 



DYSPEPSIA. 439 

sion that such cases are very rare. The predisposition to 
phthisis may be favored by the debility attendant on dys- 
pepsia, as it is by the same condition from any other cause ; 
but the former disease is probably seldom or never the 
direct result of the latter. 

It is important to distinguish chronic gastritis from 
dyspepsia, and to be able to recognize inflammation when 
it takes place in the course of the latter affection. In 
chronic gastritis the pain is on the whole more severe, the 
epigastric tenderness greater and more constant, vomiting 
much more frequent, and the pulse more tense, and, as a 
general rule, more accelerated. In this complaint the 
tongue is frequently red, with prominent papillse, or altered 
surface, which is seldom the case in pure dyspepsia. Hot 
and stimulating drinks increase uneasiness in the inflamed 
stomach, while they often afford relief to the dyspeptic ; and 
food is in general more acceptable to the latter than to the 
former. When the matter vomited is mucus, or blood, or 
like coffee-grounds, the existence of chronic gastritis may 
be inferred. Febrile action and diarrhoea are also much 
more common in that complaint than in dyspepsia. When, 
therefore, in a case of indigestion, the various symptoms 
mentioned increase or become developed, there is good 
reason to believe that gastritis has supervened. 

Treatment. — In the treatment of dyspepsia, the first and 
by far the most important indication is the removal of the 
causes. The measures requisite for this end embrace the 
regulation of the diet, the exercise, and the general habits 
of the patient, moral as well as physical. 

Diet. — The most obvious rule in relation to diet is to 
avoid the use of all substances of difficult digestion. To 
be practically useful, however, the direction must be more 
precise, and embrace an enumeration of the particular sub- 
stances to be forbidden or allowed. The following specifi- 
cation is only correct in general, for the peculiarities of 
individual stomachs are so numerous, that an article easily 
digestible by one will often prove almost indigestible by 
another, and vice versUL 

The patient, as a general rule, should avoid all culinary 



440 FUNCTIONAL DERANGEMENTS. 

vegetables, with the exceptions hereafter to be mentioned , 
all fruits, whether fresh, preserved, or pickled; all fat, 
salted, and smoked meats, and those which are tough, from 
whatever source derived. Of the particular kinds of 
animal food, pork, pig, veal, and domestic ducks and geese, 
are peculiarly difficult of digestion. The flesh of very 
3 r oung or of very old animals is usually less digestible 
than that of the same animals in the intermediate stages of 
life. Fish is generally deemed of difficult digestion, and 
most shell-fish, especially clams and lobsters, should be 
avoided by the dyspeptic. Of substances prepared by the 
culinary art, pastry; fresh, hot, and heavy bread ; puddings; 
cakes made with butter or fat ; fried meats ; hard-boiled 
eggs ; jellies ; soups ; gravy ; and all sorts of dressings 
with butter, sugar, wine, etc., should be forbidden. What- 
ever is pasty, doughy, or disposed to form a tenacious mass 
with water, resists digestion, because impenetrable by the 
gastric juice. Sausages, and cheese of all kinds, are of 
difficult digestion. Butter, lard, and other fats are espe- 
cially injurious to the dyspeptic stomach when altered by 
heat. Brown sugar, molasses, and honey, are apt to induce 
acidity of stomach. Vegetable acids have been found to 
be generally injurious ; and the fruits which contain them 
largely should be especially avoided. 

The list of allowable substances is not scanty. Among 
those of vegetable origin are wheaten bread, which should 
always be light, stale, and perfectly free from acid ; 
crackers made without shortening of any kind ; well-boiled 
rice ; and Irish potatoes, either roasted or boiled so as to be 
dry and mealy. Some object to the last-mentioned vege- 
table, and the small, waxen, or watery potatoes which are 
often met with are certainly of difficult digestion ; but when 
of good quality, they agree well with most dyspeptic 
stomachs. The sweet potato when dry and mealy, though 
sometimes flatulent, is often very acceptable, and may 
always be tried when the patient desires it. Tomatoes 
well prepared, without butter, are found to agree with many 
individuals, and prove useful by their laxative property. 
The same may be said of perfectly ripe and sweet free- 



DYSPEPSIA. 441 

stone peaches, and perfectly ripe blackberries or dewberries. 
But all these fruits may, as a general rule, be placed in the 
category of doubtful substances. 

Good fresh milk, boiled or unboiled, is usually easily 
digested, and forms an excellent diet for dyspeptics, espe- 
cially when stronger animal food may be thought hazardous, 
in consequence of existing or suspected chronic gastritis. 
It forms a good dessert when loosely coagulated by means 
of rennet, and mixed with refined sugar, nutmeg, and a 
little sound wine. Small quantities of sweet cream may be 
taken with propriety, and even agree with some stomachs 
which most other food offends. The same may be said of 
pure ice-cream, flavored with vanilla. This forms a very 
good dessert for dyspeptics, but should always be eaten 
very slowly, and allowed to dissolve perfectly in the mouth 
before being swallowed. Good fresh butter, though con- 
demned by some writers, has within my observation, when 
eaten moderately with bread, rice, potatoes, etc., proved in 
general perfectly innocent. But there is a vast difference 
in this product, and when badly prepared, or in the slightest 
degree rancid or musty, it is as offensive to the stomach as 
it is to the delicate palate. It should never be used in 
dyspepsia after having been subjected to any culinary pro- 
cess, as heat has a very injurious effect upon it. 

Among the meats, tender mutton or beef, and among 
poultry, the common fowl or turkey, is to be preferred. 
The flesh of wild animals is in general more easily digested 
than that of the tame. Good venison is perhaps the 
lightest and most digestible of meats. The American 
pheasant and partridge, and the canvas-back duck, with 
many of the smaller birds, are admissible articles. But in 
eating all sorts of fowl, care should be taken to avoid the 
skin and fat, especially when they are roasted ; and the fat 
of all the meats which have been mentioned should be 
rejected. Both meats and poultry should be kept for some 
time after being killed before cooking, so as to lessen the 
tenacity of the muscular fibre ; but they should never be 
allowed to be in the least tainted. They should be either 
boiled, roasted, or broiled. When there are symptoms of 



442 FUNCTIONAL DERANGEMENTS. 

even slight gastric inflammation, if flesh is used at all, it 
should be preferred boiled. 

There are other articles of animal food well adapted to 
dyspeptic patients, such as oysters, raw or slightly roasted ; 
sweet-bread ; the liver of calves ; turtles, cooked well with- 
out butter; and soft-boiled eggs. It is highly necessary 
that eggs should not be overdone. They should be so pre- 
pared that the albumen may be coagulated, while the yolk 
remains liquid. This is accomplished by placing them in 
boiling water, and keeping them in it for three minutes. 
The yolk of eggs may also be prepared by beating it up 
raw with water, sugar, and a little ginger. This mixture is 
well adapted for those whose stomachs will not allow them 
to pass the whole interval between the regular meals with- 
out food. Although, as before mentioned, salted and 
smoked meats are usually injurious as articles of diet, very 
small quantities of chipped beef or venison, or boiled ham, 
or a little smoked herring, may be used with impunity for 
relish. 

Condiments, such as salt, mustard, black and Cayenne 
pepper, horseradish, etc., should always be used with mode- 
ration. They occasionally prove beneficial by assisting 
digestion ; and as their stimulant effects are chiefly local, 
they are less dangerous than alcohol; but, like all other 
stimulants, if abused, they diminish the excitability, and 
thus increase the already existing debility. 

In relation to drinks, the best, upon the whole, is cool 
water. The vinous and spirituous liquors, though they 
often afford temporary relief, are positively injurious if con- 
stantly used, and always place the patient in the danger of 
acquiring intemperate habits. Should any one of them be 
employed, it should only be at dinner; and sherry or 
madeira among the wines, and brandy among the spirits, 
should be preferred. Some stomachs bear sound ale or 
porter pretty well, in moderate quantities. For the morning 
and evening meals an infusion of the chocolate nut, with a 
little sugar and milk, or a cup or two of not very strong 
black tea, may be used ; though water alone, or a mixture 
of milk, sugar, and hot water, would perhaps be preferable. 



DYSPEPSIA. 443 

Coffee should never be taken, unless it be a single cup at 
breakfast, to prevent headache in those who have become 
accustomed to its use. 

It must be remembered, however, in regulating the diet 
of dyspeptic patients, that the stomach is singularly capri- 
cious, and sometimes takes fancies, which, however contrary 
to preconceived opinion, it may be proper to indulge. Such 
fancies, when they persist for a considerable time, are 
usually signs by which nature indicates her wants. Nu- 
merous instances have been noticed in which patients have 
been benefited, if not cured, by the use of articles of food 
which, under ordinary circumstances, are highly indigestible. 
Experience, moreover, will often be a better guide, in any 
particular case, than general precepts. Care, however, 
must be taken that the judgment of the patient be not 
biased by his inclinations or prejudices. 

Almost as much depends upon the proper mode of taking 
food as upon the selection of the substances to be used. 
The patient should, as a general rule, eat at regular intervals, 
and three meals a day are usually sufficient. The stomach 
should be allowed some rest ; and the habit of eating little 
and often through the day, as well as at bed-time, so that 
the stomach may be as seldom as possible quite empty, is 
not advisable. In some cases, when the interval between 
breakfast and dinner is long, and the patient suffers much 
from an empty stomach, a few oysters, a little egg prepared 
in the manner above mentioned, or some other light food, 
may be taken about two hours before the latter meal. 
Large suppers are very injurious, as they overtask the di- 
gestive organs at a time when their energy is least. Great 
care should at all times be taken not to overload the sto- 
mach. On this account the patient should eat slowly, as 
the stomach will be more likely to give the signal of satiety 
at the proper time, when permitted to feel the full influence 
of the food as it is swallowed. Besides, it is of great im- 
portance that the food should be thoroughly masticated, so 
as to favor its solution ; and this is prevented by rapid eat- 
ing. A meal should never be taken immediately after 
fatiguing exercise, as the stomach participates in the general 



444 , FUNCTIONAL DERANGEMENTS. 

languor. The patient should not drink largely, especially 
at meals. Besides the injurious effects of distention, the 
solvent power of the gastric juice is diminished by too 
great dilution. 

Exercise. — The great object of exercise is to equalize ex- 
citement, so that each organ may have its due supply of 
blood and of nervous influence. This is accomplished by a 
combination of passive and active exercise. By the former 
the viscera are especially acted on, by the latter the whole 
of the voluntary muscles, and the structures associated 
with them in function, while both affect the nervous sys- 
tem. Of the different kinds of passive exercise, the best, 
as a general rule, for the dyspeptic, is riding on horseback ; 
the next best, riding in a somewhat rough vehicle, or over 
a rough road, as in one of our stage-coaches. These, how- 
ever, will be found too severe for some very delicate per- 
sons, especially those in whom there is a nervous tenderness 
of stomach. For such persons, driving in an ordinary car- 
riage, or travelling on railroads, or sailing may be substi- 
tuted. Of the modes of active exercise, walking is best 
for persons somewhat advanced in life ; running, leaping, 
etc., may be practiced by the young. Gymnastic exercises 
are also useful ; but care is necessary to avoid the tempta- 
tion of carrying them to extremes. In bad weather, and 
for persons who cannot conveniently leave their homes, ex- 
ercise of various kinds within doors should be contrived. 
The ordinary household duties afford abundant opportuni- 
ties for active exercise to females. When the patient can- 
not command the means or opportunities for riding, he may 
substitute the plan recommended by Halsted, or some anal- 
ogous one, for giving passive exercise to the stomach. This 
consists in bending the body forward, and so relaxing the 
abdominal muscles as to allow the hands to be pressed, 
with their palms upward, beneath the stomach, and then, 
by gentle and repeated impulses with the fingers, keeping 
up a regular movement in that organ. ■ It should not, how- 
ever, be practiced when the process is painful, or there is 
any reason to suspect inflammation of the stomach. It 
often affords relief in flatulence. 



DYSPEPSIA. 445 

Exercise should be as regular as possible, and properly 
timed in relation to the periods of eating. Violent exercise 
should never be taken immediately before or immediately 
after a full meal. In taking exercise, the dyspeptic should 
always stop short of fatigue. It is important that this 
remedial measure should not become irksome to the patient, 
and, therefore, that some other immediate object should, if 
possible, be associated with it, besides the mere promotion 
of health. It is always desirable to connect it with the 
pursuit of interest or enjoyment. Hence one of the advan- 
tages of travelling. 

General Habits. — The patient should observe regularity 
and moderation in all his habits. Excesses of all kinds are 
injurious to the debilitated stomach. He should retire 
early to bed, and rise early^, allowing from six to eight hours 
for sleep, and never permitting either pleasure, business, or 
study to encroach upon his period of rest. The sleeping 
apartment should be well ventilated, and mattresses used in 
summer instead of feather beds. Nevertheless, it would be 
injurious to sleep so lightly covered as to suffer in the least 
from cold. It is a mistake in dyspeptic individuals, to sup- 
pose that they can harden themselves in this way. Personal 
cleanliness should be rigorously observed ; but the too 
frequent or long-continued use of baths, especially of warm 
baths, is injurious by their sedative or relaxing influence. 
The cold bath, or shower bath, is to be preferred when a 
vigorous reaction follows. This, indeed, is an excellent 
remedial measure in dyspepsia. But when the system is 
too feeble to react thoroughly, the tepid bath must be used, 
and the patient should remain in it no longer than is neces- 
sary for cleanliness. When the skin is in a cold, languid 
state, the warm salt-balh will often be found useful ; and 
friction to the surface, by means of a flesh-brush or coarse 
towel, should be employed daily. Friction over the abdo- 
men is highly advantageous. The patient, moreover, in 
employing this measure, has the additional benefit of whole- 
some exercise. 

Relaxation from severe study, and from the cares and 
anxieties of harassing business, of whatever kind, is essen- 



446 FUNCTIONAL DERANGEMENTS. 

tial to the cure of dyspepsia. Yet the mind must not be 
left without occupation, as in no disease is it more apt to 
prey upon itself, when surrendered wholly to its own ca- 
prices. Innocent amusements, cheerful society, light read- 
ing, and moderate professional occupation, exercise a very 
healthful influence. Sources of mental depression should 
always, as far as possible, be removed or counteracted. All 
these objects can be accomplished in no other way so effect- 
ually as by travelling, which unites the advantages of exer- 
cise, pure air, relaxation from care, and agreeable excitement 
of the mind; and, if directed to some suitable watering- 
place, affords the additional advantage of an efficient medi- 
cinal agent. To render a journey permanently useful, it 
must be a long one ; and hence a voyage to Europe, or some 
foreign country, and an absence of six months, a year, or 
more, are among the most effectual means of curing dyspep- 
sia. It is probable that the effect produced on the stomach 
by the sea-sickness, and consequent abstinence, is advan- 
tageous in many cases. 

Medicinal Treatment. — Two principal indications are pre- 
sented in dyspepsia for the use of medicines : first, to keep 
the bowels regularly open, and, secondly, to make a mode- 
rate but durable stimulant impression upon the stomach; 
the former is to be accomplished by laxatives or enemata, 
the latter by tonics. 

It would be desirable to maintain regular evacuations 
from the bowels by means of diet alone ; but, unfortunately, 
the articles of food best calculated for this effect, such as 
the fruits and fresh vegetables, are inadmissible, from their 
difficulty of digestion and aptness to occasion acidity and 
flatulence. Bran bread, or bread made from unbolted flour, 
is not liable to this objection, and constitutes, on account 
of its laxative quality, an excellent article of diet for dys- 
peptics. It does not, however, suit all stomachs, and fre- 
quently fails in producing the effect desired. When medi- 
cines are employed, those should be selected, as a general 
rule, which have no tendency to weaken the stomach, but, 
on the contrary, unite some tonic or stimulant with their 
laxative power. Rhubarb and aloes are the most suitable. 



DYSPEPSIA. 447 

They may be given separately or combined ; and the most 
convenient period for administering them is generally at 
bed-time, so that they may act in the morning. Rhubarb 
may be used in all cases ; aloes in all, when there is no 
tendency to piles or uterine irritation. Combination with 
soap is thought to render them milder, without impairing 
their efficacy. They are usually given in pill ; but many 
persons are in the habit of chewing rhubarb, or of taking it 
reduced to powder by grating. In the latter case, it may 
be advantageously associated with grated nutmeg. When 
these medicines lose their effect by repetition, they may be 
mixed with a minute portion of croton oil. One-sixth of a 
drop will often be sufficient to communicate to them the 
requisite activity. I have found a teaspoonful of salts and 
soda, taken half an hour or an hour before breakfast, in 
half a tumblerful of water, to be an admirable laxative in 
some cases of dyspepsia. A drachm of sulphur once or 
twice a day is especially useful in cases complicated with 
rheumatism. White mustard seeds unbruised, in the dose 
of a tablespoonful, repeated as often, have been found to 
answer well in cases requiring a somewhat stimulant im- 
pression. Magnesia should be employed in cases of acidity 
of stomach. Mild laxative enemata or suppositories, applied 
daily, are sometimes usefully substituted for cathartics by 
the mouth. In general, however, they clo not sufficiently 
affect the upper bowels. 

Tonics must be used with caution. If largely employed, 
and long and steadily persevered in, there is danger that 
they may wear out the excitability of the stomach, and thus 
indirectly increase the debility they were given to relieve, 
while, at the same time, they may increase the danger of 
chronic inflammation. They should never be used as sub- 
stitutes for the course of treatment above recommended, but 
only as adjuvants; for, if administered while fhe causes of 
the disease continue to act, they can only afford present 
relief at the risk of future mischief. When the stomach is 
placed under circumstances in which, upon being excited to 
the proper point by artificial means, it can execute its func- 
tion duly without further aid, tonics may be advantageously 
29 



448 



FUNCTIONAL DERANGEMENTS. 



employed ; but they should be omitted as soon as they are 
found no longer necessary. The best for the purpose are, 
on the whole, the purer bitters, such as columbo, gentian, 
and quassia. Chamomile is well adapted to mild cases. 
Wild cherry bark may be used when an irritable circulation, 
indicated by the occurrence of palpitations or very frequent 
pulse under slight excitements, is associated with the gastric 
depression. Serpentaria is applicable to cases of unusual 
debility; and valerian may be advantageously combined 
with the bitters when the patient is affected with symptoms 
of hysteria, or other nervous functional disorder. The 
infusions of these medicines may be given in the dose of a 
wineglassful three or four times daily. Gentian and quassia 
may also be conveniently administered in the form of ex- 
tract. The tinctures should be employed cautiously, and 
only as adjuvants of the other preparations, when the 
stomach is very feeble. Of the mineral tonics, the chalybe- 
ates are to be preferred. Of these, the best are the pills 
of carbonate of iron of the IT. S. Pharmacopoeia. Sulphate 
of iron, combined with twice its weight of carbonate of soda, 
or carbonate of potassa, and incorporated, either in liquid 
mixture or pill, with honey or syrup, affords a good substi- 
tute for this preparation when it does not happen to be at 
hand. Subcarbonate of iron, tincture of chloride of iron, 
and solution of iodide of iron, are also good preparations. 
The chalybeate mineral waters, which usually contain the 
carbonate of iron dissolved by means of carbonic acid, are 
among the best tonics in dyspepsia. Besides the substances 
mentioned, sulphuric, nitric, and muriatic acids, subnitrate 
of bismuth, sulphate of zinc, and nitrate of silver, are 
sometimes used. Carbonic acid water is also an excellent 
tonic in dyspepsia, and usually very acceptable to the 
stomach, but, like all others, is liable to be abused. A cur- 
rent of electricity or galvanism made to pass through the 
stomach is sometimes useful when that organ is peculiarly 
torpid. 

Advantage will often accrue from the combination of 
medicines to meet different indications. Thus, the bitter 
tonics may be associated with the aromatics, and, when a 



DYSPEPSIA. 449 

laxative effect is desired, with the cathartics. An infusion 
of columbo, ginger, and senna is an excellent preparation, 
from which I have derived great advantage in dyspepsia. 
Rhubarb, among the cathartics, and orange peel, cloves, 
cardamom, fennelseed, etc., among the aromatics, may in like 
manner be connected with the bitters ; and, when there is 
excess of acid in the stomach, one of the alkaline carbonates 
may be added to the infusion. The extracts of gentian and 
of quassia may be combined, in pills, with rhubarb or aloes, 
and one of the chalybeates, and, when a carminative effect 
is desired, with an aromatic volatile oil. 

In relaxed conditions of the system, attended with im- 
perfect digestion, flatulence, and looseness of the bowels, 
the anodyne carminative^ recommended in a like condition in 
cholera infantum, is a most excellent remedy. If taken 
after meals, it will generally render digestion more perfect ; 
prevent acidity and the generation of gas, and prevent the 
food from passing so hastily through the stomach and 
bowels as not to allow time for the proper changes to be 
wrought upon it, or its nutrient particles absorbed by the 
lacteals ; so that the patient, though taking sufficient food, 
is not nourished, and the half-digested aliment, by irritating 
the bowels, serves to quicken their motion and continue the 
complaint. 

But if the opposite condition obtains, and there is a 
feverish condition of the system, depraved appetite, and 
slowness of the bowels, the following formula will be best : 

R Extract of Hyoscyamus, 1 ounce. 
" " Butternut, 7 ounces. 
Oil of Sassafras, \ ounce. 

Sup. Carb. Soda, 2 ounces. 

Simple Syrup, 2 quarts. 

Of this anodyne alterant the patient may take one or two 
teaspoonfuls after eating, and if this should not prove suffi- 
cient to keep up regular actions from the bowels, a table- 
spoonful may be taken at bedtime. This prescription will 
be found to answer a most valuable purpose in very many 
cases of dyspepsia, as it fulfils almost every indication 
which we ordinarily have to meet in the management of 
the disease, viz. : allays nervous excitement, eases pain, and 



450 FUNCTIONAL DERANGEMENTS. 

procures rest; neutralizes acidity; improves the tone of 
the stomach and bowels ; excites the liver ; and keeps up a 
regular and natural motion of the bowels. If the liver 
should prove to be very torpid, a blue-pill taken at night a 
few times, in addition to the alterative syrup, will assist it 
in obtaining bilious discharges, after which the alterative 
alone will keep it up. 

A great advantage obtained by the use of the above pre- 
scriptions is, that they give immediate aid to the digestive 
powers, so that food in sufficient quantity to afford strength 
to the system can generally be taken with impunity. A 
lady some years since consulted the author with regard to 
a most distressing headache, from which she suffered daily, 
and had for years with little intermission : she* was found 
to be a confirmed dyspeptic ; had torpid liver and bowels ; 
a peculiar heaviness and distress was experienced in the 
region of the stomach for some time after eating even ever 
so little, followed by a severe paroxysm of headache; in 
consequence of which she had abstained from food until the 
system had suffered exceedingly for want of nourishment. 
I prepared for her the anodyne alterant, and directed her to 
take a large teaspoonful soon after eating each meal, and a 
tablespoonful at night ; and, as there was tenderness in the 
region of the stomach, a mush poultice sprinkled with mus- 
tard, made large enough to extend also over the liver as 
well as the stomach, was directed to be applied on going to 
bed, and remain until morning; and several times during 
the day the whole abdomen was directed to be bathed with 
chloroform liniment. This treatment proved so successful, 
that almost all suffering was relieved in a few days, and in 
four weeks she had gained eighteen pounds in weight. 
After a few weeks, the medicine was discontinued at my 
suggestion, and only used occasionally, when some exposure 
or imprudence in diet threatened a return of the disease. 

IRRITATION OF STOMACH. 

By this term is meant any morbid excitement of the 
stomach, not amounting to inflammation. Instances of dis- 
order of this kind are exceedingly common, although not 



IRRITATION OF STOMACH. 451 

usually associated by writers under this name, and often 
too much neglected in practical treatises. Though seldom 
in itself dangerous, irritation of stomach is in many of its 
forms very distressing to the patient, and, if not arrested, 
very often terminates in gastritis, either chronic or acute. 
It presents itself in a variety of forms, dependent on the 
tissue or function affected, the nature of the cause, and the 
previous condition of the stomach or the system. It some- 
times affects the capillaries especially, sometimes the nerves 
exclusively, and often both at the same time. Though most 
frequently merely the antecedent of inflammation of the 
stomach, and very often only a secondary or attendant 
affection of other diseases, it yet has in numerous instances 
an independent existence, and therefore requires an inde- 
pendent consideration. The affection is often attended with 
a sense of fulness, weight, or uneasiness in the epigastrium, 
sometimes amounting to pain. The appetite is somewhat 
impaired, the tongue often slightly furred near the root, the 
stools scanty or light-colored from deficiency of bile, the 
complexion sometimes sallow, and the mind irritable or 
depressed, and disposed to view every thing in a gloomy 
light. The condition is one of those to which the name of 
bilious complaint is often vaguely applied. It is a frequent 
antecedent to bilious fevers, cholera morbus, jaundice, and 
vomiting of blood ; and there is reason to believe that some 
of these diseases might often be prevented by its timely 
treatment. It occurs most commonly at the commence- 
ment or during the prevalence of hot weather, but is found 
at all seasons. 

Irritation is often occasioned by offending matter in the 
stomach; the symptoms then are of a variable character, 
sometimes not exceeding a morbid feeling of heat, or a 
slight gnawing sensation, sometimes amounting to burning 
pain, or cardialgia, and occasionally gastralgic or spasmodic. 
Some of the most violent cases of spasm of the stomach 
that I have witnessed, have arisen from the presence of 
indigestible food. This uneasiness is frequently associated 
with nausea, and occasional but ineffectual efforts to vomit, 
or with eructations of fetid, sour, acrid, or bitter fluid, 



452 FUNCTIONAL DERANGEMENTS. 

according to the nature of the cause. The pulse is generally 
slow, sometimes more feeble than, in health, the skin often 
cool, and the tongue either unaltered, or slightly furred 
towards the root, or covered with a clammy mucus. Among 
the sympathetic affections are often pains over the eyes, in 
the loins and extremities, chilliness, urticaria or other erup- 
tive affections, and sometimes a loss of sense and motion as 
in apoplexy. In children and delicate females, the nervous 
disorder amounts sometimes to convulsions. When the 
sympathetic affection is considerable, the gastric symptoms 
are usually masked, and wrong inferences may be drawn. 
Under these circumstances the existence of nausea, or some 
tenderness on pressure in the epigastrium, will often indi- 
cate the real seat of the disease. After a variable period, 
either full vomiting takes place, or the contents of the 
stomach pass downward through the pylorus ; and, in both 
cases, prompt relief is obtained. Occasionally, however, 
when the irritation has been considerable and protracted, 
the depression following the excitement is so great as to 
incapacitate the stomach, for one or two days or more, for 
the proper performance of its functions. Should the cause 
continue to act, inflammation becomes established. 

Excess in drinking or eating; indigestible food; sub- 
stances which from idiosyncrasy disagree with the patient ; 
acrid medicines and poisons ; the products of acid fermenta- 
tion, or other chemical change in the food after it has been 
swallowed ; excess of acid in the gastric liquors, and other 
acrid secretions of the stomach; bile which has ascended 
from the duodenum ; worms in the stomach ; are the most 
frequent agents in the production of this variety of gastric 
irritation. There is some little difference in the operation 
of these causes. Thus, indigestible food is most apt to 
produce spasm of the stomach, acid or other acrid matters 
to occasion cardialgia or heartburn, and excess of bile to 
provoke vomiting. The results may take place in a 
stomach otherwise healthy, if the cause be sufficiently 
intense ; but when the irritation proceeds from substances 
used as food, it is most easily induced by eating heartily 
when the stomach is temporarily debilitated, as after violent 



IRRITATION OF STOMACH. 453 

exercise, by which nervous energy is diverted from the 
viscera to the muscles. The character of the offending 
matter may often be known by the taste or color of the 
matter discharged by eructation. Worms are often indi- 
cated by a sense of choking, and frequeut ineffectual efforts 
to vomit, as if there were some foreign body in the throat. 

Treatment. — This is very simple. In mild cases, absti- 
nence or the use of a very restricted diet for a clay or two 
will be sufficient. In severer cases, the most effectual 
remedy is an emetic. When the patient is disposed to 
vomit, large draughts of warm water, or of warm chamomile 
tea, will often be sufficient to evacuate the stomach. I 
have seen the most violent spasm, which had resisted 
powerful anodynes and nervous stimulants, give way imme- 
diately after vomiting produced by a copious draught of 
warm molasses and water. When an emetic is necessary, 
ipecacuanha should be preferred, and its administration 
accompanied with free dilution. Large draughts of warm 
water sometimes prove useful without vomiting, probably in 
part by diluting the acrid contents of the stomach, in part 
by promoting the peristaltic motion downward by means of 
the distention they occasion. After the evacuation of the 
stomach, an aperient may often be advantageously given ; 
such as magnesia, one of the saline cathartics, especially 
the seidlitz powder, castor oil, infusion of rhubarb, etc. If 
the cause of irritation be an acid matter, the antacids may 
be resorted to originally. Magnesia is the most efficient; 
but the carbonates and bicarbonates of soda and of po- 
tassa, and, in cases of enfeebled stomach, the anodyne 
carminative, will prove to be of great service. (See Cholera 
Infantum.) The remedies applicable in the case of worms 
will be mentioned when the effects of these parasites are 
treated of. Should spasm continue after the removal of the 
cause, it must be treated by anodynes, nervous stimulants, 
and revulsives to the epigastrium. 

Gastric irritation arising from functional or organic disor- 
der in the spinal marrow, semilunar ganglions, or other 
sources of nervous supply to the stomach, is a very com- 
mon affection, especially in females, and is often very inju- 



454 FUNCTIONAL DERANGEMENTS. 

riously confounded with dyspepsia. It is attended, in 
different cases, by almost every variety of symptom by 
which the stomach is capable of expressing its suffering. 

It is obvious that those cases must be the most obstinate 
which depend on organic disease of the spine. Such cases 
are easily recognized. So also are those in which the spine 
is painful on being pressed, in the region opposite to the 
stomach. The most obscure cases are those in which the 
ganglia or nervous plexuses are the source of the mischief. 
These must always be more or less conjectural. It is 
always important, in doubtful gastric affections, to make 
pressure on the spinous processes of the vertebrae ; as 
very often a seat will thus be discovered for the effectual 
application of remedies. 

The most effectual remedy is leeching or cupping upon 
the spine, at the point where tenderness is discovered upon 
pressure. Almost instant relief is sometimes obtained in 
this way. It is often, however, necessary to repeat the 
local bleeding, and, in some cases, several times, before a 
cure is accomplished. When the complaint does not yield 
to this remedy, blisters may be applied over the spine at 
the spot affected ; and, in cases of a chronic character, pus- 
tulation by croton oil or tartar emetic, sustained for a consider- 
able time, will be- found very useful. The diet should con- 
sist chiefly of farinaceous substances, as stale bread, 
crackers, boiled rice, gruels, etc., in acute cases ; but, when 
the appetite is unimpaired, the light and most digestible 
kinds of animal food may be employed. The bowels must 
be kept regularly open by mild aperients or enemata. 

Such is the connection between the stomach and other 
parts of the system, that it suffers more or less with almost 
every severe disease, wherever it may be seated. Thus, it 
is one of the first organs to participate in that general 
movement denominated fever, no matter what may be the 
origin of the affection. A violent injury in any part of the 
body is not unfrequently attended with' nausea and vomit- 
ing. But the organs with which the stomach appears to 
have the closest connection, are the brain, the abdominal 
viscera, and the parts concerned in the reproductive func- 



IRRITATION OF STOMACH. 455 

tion, especially the uterus. Of the phenomena, however, 
which arise through sympathy with these organs, as well as 
of the requisite modes of treatment, it is unnecessary to 
spea,k here ; as they will be fully considered under other 
heads. 

CARDIALGIA HEARTBURN. 

This sensation may, indeed, be considered as characteris- 
tic of inflammation or vascular irritation of the stomach, in 
contradistinction to mere nervous irritation. It is a very 
common attendant upon the presence of acrid matters in 
the stomach, and has been looked upon almost as diagnos- 
tic of acidity. It is to be relieved, of course, by the reme- 
dies calculated to remove the condition of which it is a 
symptom. 

GASTRALGIA GASTRODYNIA NEURALGIC PAIN IN THE STOMACH. 

Causes. — Gastralgia may proceed from disease of the 
spinal marrow or sympathetic nerve, from gout or rheuma- 
tism affecting the stomach, or from certain not very accu- 
rately defined conditions of the system, which constitute a 
predisposition to neuralgia in general. It not unfrequently 
occurs in the convalescence from acute diseases, and in 
debility from other causes, such as meagre diet, impaired 
digestion, profuse evacuations, and especially the loss of 
blood. Anemic and hysterical females are very subject to 
it. Anxiety of mind, and the habitual influence of strong 
and contending emotions, frequently act as predisposing 
causes. When the predisposition exists, the slightest cause 
is sufficient to bring on an attack of the pain. Any dis- 
turbing emotion, any local affection which may react sym- 
pathetically on the stomach, even the mildest articles of 
food or of drink, are capable of inducing a paroxysm. 

Diagnosis. — The only affection with which pure gastral- 
gia is liable to be confounded, is inflammation of the 
stomach. It wants the febrile symptoms, the great prostra- 
tion, the nausea and vomiting, and the steady course which 
mark acute gastritis, for which, therefore, it can scarcely be 
mistaken. From the chronic form of the disease it is not 



456 FUNCTIONAL DERANGEMENTS. 

always so easily distinguished ; the symptoms in the latter 
being so variable, that it is impossible to institute a precise 
comparison applicable to all cases. No one symptom in the 
following catalogue can be considered as uniformly diagnos- 
tic ; but the whole, taken together, will lead almost always 
to a correct conclusion. 

The pain in gastralgia is usually severe, uncomplicated, 
and often capricious, occurring irregularly, and sometimes 
leaving the patient altogether for a time. Instead of being 
increased, it is often relieved by pressure, though this is 
not invariably the case. In chronic gastritis, it is usually 
dull, often complicated with burning or other disordered 
sensation, more steady, seldom being entirely wanting, and 
almost always aggravated by pressure in the epigastrium. 
In the former affection, the appetite, though variable, is 
often unimpaired, vomiting and excessive thirst unusual, and 
digestion frequently as vigorous as in health ; in the latter, 
the appetite usually suffers, nausea and vomiting are not 
uncommon, the patient is apt to be annoyed with thirst, and 
digestion is almost always impeded. The tongue in gas- 
tralgia is not unfrequently healthy, the skin cool, and the 
pulse quite undisturbed ; while in chronic gastritis, though 
the same condition of these parts may sometimes exist, the 
contrary is more frequently the case. The neuralgic affec- 
tion may be attended with various sympathetic nervous dis- 
turbances, such as dyspnoea, palpitation, restlessness, morbid 
vigilance^ etc.; but wants the extreme emaciation and hec- 
tic symptoms which mark the advanced stage of the inflam- 
mation. The spirits in both are usually depressed, but in 
gastralgia are more variable, being excessively low during 
the paroxysms, and again bright and cheerful when the 
pain remits or retires. Hot and stimulating drinks, in gen- 
eral, aggravate chronic gastritis, while they often relieve 
gastralgia. In both, constipation is an almost constant 
attendant, unless the case is complicated with chronic en- 
teritis, which is much more likely to happen in the inflam- 
matory than in the nervous affection. Not unfrequently 
the two affections are combined in the same case, and the 
diagnosis thus obscured. In doubtful cases, it is safest to 



IRRITATION OF STOMACH. 457 

treat the disease as chronic inflammation, and, if the meas- 
ures employed fail, then to address our remedies to the 
neuralgic condition. 

Treatment. — The most urgent indication, in severe cases, 
is for immediate relief from pain. For this purpose, ano- 
dynes must be used internally, and a strong impression 
made upon the epigastrium by rubefacient or epispastic 
applications. Opium, or some one of its preparations, is 
the most efficient anodyne ; but other narcotics, as hyoscya- 
mus, stramonium, belladonna, and lactucarium, separate or 
combined, may often be advantageously resorted to, espe- 
cially when it is necessary to sustain a constant impression 
for a considerable time. Hydrocyanic acid has also been 
highly recommended; the smoking of tobacco has some- 
times proved beneficial. Where a sudden but fugitive 
external impression is desired, a sinapism should be applied 
over the stomach ; when the impression is to be more per- 
manent, a blister of Spanish flies. Both indications may 
be met by the use of strong solution of ammonia, or paper 
saturated with chloroform liniment. Advantage will some- 
times be found in sprinkling morphia over the blistered sur- 
face, deprived of the cuticle. 

A second indication is to change that condition, whether 
of the stomach or of the system, upon which the predispo- 
sition to the disease depends. When the gastralgia is asso- 
ciated with debility, as in convalescence from febrile diseases, 
this object may often be effected by the use of tonics. I 
have seen the affection speedily give way to the pure vege- 
table bitters, or to quinine. The former may be given in 
infusion with aromatics, and a little senna or rhubarb. The 
latter is an almost certain remedy when the disease is regularly 
intermittent. In anemic cases the chalybeates are preferable. 
The alterative mineral tonics have enjoyed great reputation 
in the disease. Nitrate of silver was recommended by Dr. 
James Johnson ; but subnitrate of bismuth has been more 
employed. The latter preparation should be given in the 
dose of from three to five grains three times a day. All 
these remedies may be advantageously combined with 
opium or the narcotic extracts. It should always be ascer- 
tained whether the disease is connected with spinal irrita- 



458 FUNCTIONAL DERANGEMENTS. 

tion, and if so, the remedies should be applied accordingly. 
If it be of rheumatic or gouty origin, in addition to other 
measures, stimulant applications should be made to the 
extremities. To meet this same indication, all those means 
should be employed which are requisite for confirming the 
general health, such as exercise in the open air, sleeping in 
well-ventilated apartments, and in summer upon mattresses 
instead of feather beds, relaxation from the anxieties and 
fatigues of business, and cheerful society and agreeable 
recreation when attainable. 

PYROSIS WATERBRASH. 

Pyrosis usually occurs in paroxysms. It commences 
with a sense of constriction and pain at the pit of the 
stomach, which is increased by an attempt to assume the 
erect posture, and thus causes the patient to lean forward. 
The pain is often very severe, and is sometimes attended 
with a burning sensation. After a while, the patient dis- 
charges by eructation considerable quantities of a thin 
watery fluid, which is generally quite tasteless, though 
sometimes, probably from accidental causes, sour or acrid. 
Under this discharge, the pain gradually lessens, and ulti- 
mately ceases altogether. The fluid is not usually thrown 
off at once, but by repeated eructations, which continue for 
a considerable time. The attacks most commonly occur in 
the morning or forenoon, when the stomach is empty, but 
often also at other periods. When they have once occurred, 
they are apt to be repeated at varying intervals for a great 
length of time. In the intervals, the patient is often exempt 
from dyspeptic or other morbid gastric symptoms, thus 
proving that the affection is not essentially dependent upon 
dyspepsia or chronic inflammation of the stomach, although 
it may be associated with those diseases. 

Causes. — The causes of pyrosis are not well understood. 
It occurs most frequently among those who are meagrely 
fed, and at the same time indulge in spirituous liquors. It 
is confined to no class, nor to any particular mode of life. 
It seldom, however, occurs before the age of puberty, or in 
old people. According to Cullen, its attacks may be brought 



IRRITATION OF STOMACH. 459 

on by cold applied to the lower extremities, or by any con- 
siderable emotion of the mind, but for the most part occur 
without any known exciting cause. 

Nature. — As to the nature of the affection, we may infer 
from the symptoms that it is a combination of gastralgia, or 
neuralgic pain of the stomach, with vascular irritation of 
the mucous membrane, occurring paroxysmally, and relieved 
at each attack by a copious elimination of fluid from the 
exhalent vessels of the stomach. The pain does not appear 
to be produced by the presence of the fluid, which is usually 
quite bland, but to be relieved by the production of the 
fluid. In this respect, it differs entirely from carclialgia, or 
heartburn, in which the uneasiness is excited by the irri- 
tating character of the contents of the stomach. The two 
affections, however, may coexist, especially in dyspeptic 
cases ; and in such we may have the burning pain and acrid 
or sour discharges, along with the paroxysms of pyrosis. 
The complaint is confounded by some writers with gas- 
trorrhoea, or catarrh of the stomach. But in the latter the 
discharge is mucous, and proceeds probably from the mucous 
follicles, either inflamed, or in that relaxed condition which 
sometimes follows inflammation. 

Treatment. — The pain maybe relieved by opiates or other 
narcotics, conjoined, if necessary, with revulsive applications 
to the epigastrium. If the liquid discharged be sour, mag- 
nesia, bicarbonate of soda or potassa, or aromatic spirit of 
ammonia may be united with the anodyne. But this treat- 
ment is only palliative. The curative processes must be 
applied in the intervals. If chronic gastritis exist, the 
measures should first be directed to the cure of that affec- 
tion. If there be no inflammation, the patient should be 
put upon the course of treatment, as respects medicine, 
regimen, and modes of life, applicable to dyspepsia. Some 
particular remedies, however, have been recommended as 
especially useful in this affection. Among these, the most 
prominent is sub-nitrate of bismuth, given in three or four 
grain doses three times a day. Nitrate of silver may also 
be employed with prospect of advantage. Oxide and sul- 
phate of zinc have been recommended. Much may be 



460 FUNCTIONAL DERANGEMENTS. 

expected from sulphate of quinine freely administered, iu 
cases entirely free from symptoms of inflammation. Dr. 
Caldwell states that he has known cures effected by the 
use of lime-water and milk, with blisters to the epigas- 
trium. 

SPASM OF THE STOMACH CRAMP OF THE STOMACH. 

By these terms is meant any painful morbid contraction 
of the muscular coat of the stomach. The ordinary peris- 
taltic movement may become painful, in consequence of an 
inflamed or highly sensitive state of the muscular fibre, or 
of the parts moved by its contractions. In such cases the 
affection is not spasmodic. Spasm of the involuntary mus- 
cles bears the same relation to their ordinary healthy con- 
traction that a similar affection of the voluntary muscles 
does to their voluntary movements. These are often pain- 
ful without being spasmodic, as for example in rheumatism. 
To constitute spasm of the stomach, therefore, it is neces- 
sary that the contraction should not only be painful, but 
unusual, either in degree or direction. This disorder is very 
analogous to gastralgia ; but in the latter there is not neces- 
sarily any unusual movement of the stomach. The two 
conditions, however, often coexist. 

Spasm of the stomach is characterized by a sense of pain 
and stricture or contraction in the epigastrium, occurring in 
paroxysms, with a remission or complete intermission of 
pain in the intervals. The stomach sometimes feels as if 
drawn towards the back, sometimes as if gathered into a 
ball. The pain varies somewhat in position, being diffused 
over the epigastrium, or confined to a portion of it, accord- 
ing as the whole or a part of the stomach is affected. 
Sometimes it extends up into the breast, when the oesophagus 
participates in the spasm. During the paroxysm, the patient 
usually holds himself in a bent position. Nevertheless, the 
pain, so far from being increased, is ordinarily somewhat 
relieved by pressure from without, although, after the sub- 
sidence of the spasm, the stomach is left sore and tender to 
external impression. This is an important fact in reference 
to diagnosis. All violent spasmodic action is apt to be 



XKRITATION OF STOMACH. 461 

followed by a feeling of soreness or tenderness, as if the 
part had been severely pinched. Tenderness in the epigas- 
trium, therefore, remaining after a paroxysm of gastric 
spasm, must not be considered as an evidence of inflamma- 
tion. The pain is in various degrees, from a slight fugitive 
affection, which scarcely merits notice, up to the most violent 
of which the human frame is susceptible. Perhaps no 
physical agony is greater than that of the severest spasm 
of the stomach. Strong and determined men sometimes 
scream under its violence. In moderate cases, little sympa- 
thetic disturbance of any kind is experienced; the pulse 
and skin both remaining nearly in their ordinary state. 
But when the spasm is violent, a shock is extended through 
the nervous centres to the whole system, somewhat analo- 
gous to that which results from a sudden and severe injury. 
The skin becomes cool and clammy, a cold sweat stands 
upon the brow, and the pulse is reduced in strength so as 
sometimes to become fluttering, or scarcely perceptible. 
Indeed, the shock is occasionally fatal, the vital actions 
ceasing entirely under the tremendous concentration of 
nervous energy in the stomach. Thus death sometimes 
occurs from the effects of indigestible food, or of gout 
translated from some other organ to the stomach. Nausea 
and vomiting are not usual in spasm of the stomach, unless 
when the latter depends upon some offending matter in the 
viscus. In such cases, the nausea is experienced between 
the paroxysms, being replaced during their continuance by 
the more violent sensation. In the act of vomiting, the 
stomach often contracts spasmodically, and occasions excru- 
ciating pain. 

Causes. — Whatever irritates the mucous coat may throw 
the muscular sympathetically into spasm, especially when 
there is a strong predisposition to that affection. Hence, it 
is frequently caused by indigestible food, such as boiled 
cabbage, cucumbers, etc., by substances which disagree with 
the stomach in consequence of idiosyncrasy, and by irritating 
matters in the stomach, whether the result of alteration in 
the food or of secretion, as acid in excess, acrid gastric 
juice, and bile regurgitating from the duodenum In all 



462 FUNCTIONAL DERANGEMENTS. 

these cases, the occurrence of nausea in the intervals be- 
tween the spasms, and occasional eructations or abortive 
efforts to vomit, will sometimes serve to indicate the nature 
of the cause. Another common cause is the collection of 
air, either resulting from the fermenting food, or from a 
secretory act of the stomach. This will often be indicated 
by belching. Spasm of the stomach may be occasioned also 
by congestion of the portal system of veins, by irritation 
of the spinal marrow or sympathetic nerve, by gout or 
rheumatism, by cold externally applied, especially to the 
extremities, and by very cold water taken into the stomach 
when the body is overheated or perspiring. In many per- 
sons, a strong predisposition to the affection exists. We 
find it especially in those debilitated by improper indulgences, 
irregular modes of life, the long continuance of depressing 
emotions, or certain chronic disorders affecting particularly 
the nervous system. Hysterical females and gouty and 
dyspeptic individuals are peculiarly subject to it. When 
the predisposition exists strongly, very slight causes are 
sufficient to bring it into action. 

Treatment. — This must vary with the cause, and the pre- 
cise measures necessary will be indicated in connection with 
the complaints of which this affection is an accompaniment. 
It will be sufficient here to point out the remedies in a gen- 
eral way. If the spasm proceed from offending matters in 
the stomach, especially from undigested food, these should 
be evacuated by an emetic of ipecacuanha, which should be 
followed by a mild cathartic. When the affection is not 
severe, it will be sufficient, instead of the emetic, to admin- 
ister a dose of castor oil with laudanum. If the offending 
matter be acid, magnesia or other antacid should be given ; 
and the aromatic spirit of ammonia will be found peculiarly 
useful from its stimulant properties. After vomiting, if that 
should be deemed necessary, and if not, immediate recourse 
must be had to anodynes. In severe cases, two or three 
grains of opium, or an equivalent dose of laudanum, black- 
drop, or one of the salts of morphia, should be given at 
once, and repeated every half-hour or hour till relief is 
obtained. The opiate may in general be given in connection 



IRRITATION OF STOMACH. 463 

with the cathartic or antacid, when these are considered 
necessary. In the absence of all inflammation, or high 
vascular excitement of the stomach, certain stimulants, 
especially the nervous, such as Hoffmanns anodyne, ether, 
musk, and the preparations of ammonia, may be usefully 
conjoined with jthe anodyne. If the spasm be caused or 
accompanied by flatus, the aromatics may be freely used, as 
the essence of peppermint, spearmint, or pennyroyal, ginger 
tea, the compound spirit of lavender, compound tincture of 
cardamom, oil of turpentine, etc. External applications, 
such as have been mentioned under gastralgia, should never 
be neglected. The most efficient, on the whole, is a sina- 
pism of pure mustard. Obstinate spasm of the stomach 
has yielded immediately to the revulsion produced by a 
large cupping-glass applied to the epigastrium. Should the 
spine be in fault, the remedies should be applied in that 
part. In gouty and rheumatic cases, the irritation should 
be invited to the extremities by rubefacient applications. 
To relieve the predisposition to spasm, the treatment must 
be directed according to the condition of the system and the 
particular state of the stomach. The measures recommended 
in gastralgia will be found useful here. 

NAUSEA AND VOMITING. 

The stomach throws up its contents in two different 
modes : first, by regurgitation or eructation, which is effected 
by the contraction of the stomach, assisted sometimes by 
the voluntary contraction of the diaphragm and abdominal 
muscles ; and, secondly, by vomiting, which is the result of 
various combined involuntary movements, made through the 
instrumentality of the brain. The former is not essentially 
a morbid action, as it often occurs in health. It is to the 
latter that the following observations refer. 

Phenomena. — Vomiting is very generally, though not 
always, preceded by the peculiar condition denominated 
nausea, or sickness of stomach. This is a distressing sensa- 
tion always referred to the stomach, unattended with pain, 
and of so peculiar a character as not to admit of description. 
It is accompanied, in various degrees, with a feeling of gen- 
30 



464 FUNCTIONAL DERANGEMENTS 

eral languor and debility, a small, feeble, often irregulai 
pulse, a pale, cool, and moist skin, general muscular relaxa- 
tion, rigors and trembling, sunken features, and an increased 
flow of saliva, and probably also of bile. At different periods 
after the commencement of the nausea, varying from a few 
seconds to several hours, the diaphragm and abdominal 
muscles contract suddenly and convulsively upon the stomach, 
the muscular coat of which also contracts, while the oeso- 
phagus, which is ordinarily in a state of constriction at the 
cardiac orifice, relaxes so as to allow the passage of the 
gastric contents upwards. All these movements are simul- 
taneous. In some instances, the oesophagus appears to relax 
only partially, or not at all ; and then those ineffectual efforts 
to vomit take place which are denominated retching. Occa- 
sionally the nausea continues long, and is very distressing, 
without the occurrence of either vomiting or retching ; and, 
in rare instances, vomiting appears to come on suddenly and 
unexpectedly, without any preceding nausea, or at least 
with a degree of it so slight as not to attract notice. During 
the act of vomiting, the return of the blood from the head 
is impeded by the contraction of the muscles, and there is 
consequently flushing of the face, with swelling of the 
external parts of the head, and a feeling of fulness and 
distention in the temples, which is sometimes painful. 
Apoplexy has resulted from the pressure made on the brain 
in the act of vomiting. The pulse becomes slower and fuller, 
probably in consequence of this pressure. The stomach 
sometimes contracts so violently as to produce a painful 
feeling of spasm. When the vomiting subsides, the patient 
is generally left in a state of universal relaxation, with a 
soft pulse, a moist skin, and a disposition to sleep. 

Causes. — The most common immediate cause of vomiting 
is inflammation or irritation of the stomach. The result 
equally takes place, whatever may be the cause of the in- 
flammation or irritation, whether offending matter in the 
stomach, vicissitudes of temperature, congestion of the 
portal veins, rheumatic or gouty disorder, translated cuta- 
neous affections, spinal irritation, or direct sympathy with 
other organs in a state of inflammation. Evidence is very 



IRRITATION OF STOMACH. 465 

often afforded, as to the precise cause, by the nature of the 
substances vomited. If these be excessively sour, very 
acrid, or very bitter, the vomiting may in general be inferred 
to proceed from acid, bile, or other offending matter in the 
stomach; if they consist of mucus, or of substances swal- 
lowed not in themselves irritating, it may, for the most 
part, be ascribed to the morbid state of the stomach itself; 
and whether this be inflammation or irritation, direct or 
sympathetic, must be decided by the symptoms. But the 
ejection of bile must not always be considered as a certain 
evidence of its presence in the stomach previous to the 
commencement of vomiting, for the pressure on the gall- 
bladder during vomiting, and the probable increase of the 
hepatic secretion during nausea, may cause an increased 
flow into the duodenum, the action of which viscus, as well 
as that of the stomach, is often inverted in emesis. Disease 
of the abdominal viscera, and of the uterus, is very apt to 
occasion vomiting. In these cases, it may result from a 
direct extension of irritation to the stomach, or from an 
impression made by these organs intermediately upon the 
brain. There seems to be a state of the nervous system, 
resulting from various causes, which disposes to that cere- 
bral action essential to vomiting. Such a state results from 
violent spasm of internal organs, as of the biliary ducts, 
the ureters, and the. bowels ; from severe injuries produced 
by external violence, as by blows, falls, and sometimes even 
by surgical operations ; from the loss of blood, the use of 
the warm bath, and other causes which induce faintness ; 
from the depression attending the cold stage of idiopathic 
fevers ; and from certain peculiar influences disturbing to 
the nervous system, such as occur in exanthematous fevers, 
pregnancy, and unaccustomed motions of the body, as in 
sailing, swinging, riding backwards in a carriage, etc. Dis- 
orders of the brain itself very frequently produce nausea 
and vomiting. Obstinate vomiting is one of the most char- 
acteristic features of hydrocephalus. Concussion and in- 
flammation of the brain are frequently attended with it, as 
are also various functional derangements of that organ, pro- 
ducing giddiness or swimming of the head, cephalalgia, etc. 



466 FUNCTIONAL DERANGEMENTS. 

It would appear, from what has been said, that vomiting 
cannot always be considered as arising from gastric irrita- 
tion, but that, on the contrary, it is not an unfrequent at- 
tendant upon great depression of the system. Even direct 
depression of the stomach itself would seem to be capable 
of producing it. Thus, draughts of tepid water often occa- 
sion nausea and vomiting, probably by their relaxing or 
depressing influence ; for the same quantity, either hot or 
cold, does not produce the same effect, proving that it is not 
by the stimulus of distention ; and the temperature, being 
about the same as that of the stomach, cannot be the ex- 
citing cause. When the liquid is taken either hot or cold, 
the direct stimulus of the heat in the one case, and the 
indirect stimulus of the cold in the other, obviates the de- 
pressing influence of the liquid. 

Treatment. — It is obvious that, in the treatment of vomit- 
ing, regard must be had to the pathological condition upon 
which it depends, and remedies employed accordingly. Gas- 
tric inflammation or irritation must be relieved by the means 
pointed out under these heads. When the spine is in fault, 
the remedies must be addressed to that part. When the 
vomiting proceeds from the retrocession of external diseases, 
attempts should be made to recall the irritation to the sur- 
face or extremities by rubefacient, pustulating, or blistering 
applications. When it is a purely sympathetic affection, 
the real disease should be attacked in its proper seat. But 
there are certain modes of treatment, applicable to sick sto- 
mach under most circumstances, which it is proper to men- 
tion here, in order to avoid frequent repetitions. 

Whenever there is reason to suspect that the vomiting is 
sustained by offending matters in the stomach, as, for exam- 
ple, when small quantities of bilious matter are thrown up 
at each effort, the stomach should be well cleared out by 
the free use of warm water, warm chamomile tea, chicken 
water, or other mild liquid, assisted, if necessary, by a 
moderate dose of ipecacuanha. In cases wholly free from 
inflammation, this treatment will often prove effectual, even 
though the vomiting may not depend upon the presence of 
an irritant. A tumbler-full of very warm water sometimes 



IRRITATION OF STOMACH. 467 

immediately settles a disturbed stomach, without being 
vomited. 

After the stomach has been thus cleansed, if such cleans- 
ing should be necessary, the most efficient remedy, beyond 
a]l comparison, is opium. This may be given in the form 
of pill, of tincture, or of camphorated tincture, [paregoric] 
The dose may be from the sixth of a grain to a grain of 
opium, or an equivalent quantity of its preparations, and 
may be repeated every hour or two, if required. Should 
the remedy be rejected by the stomach, it may be given 
very advantageously by enema. An anodyne injection of 
from thirty to sixty drops of laudanum, with two fluid- 
ounces of thin starch, or some mucilaginous liquid, is a most 
excellent remedy in vomiting. Should this be resisted, 
half a grain of morphia may be sprinkled upon a small blis- 
tered surface upon the epigastrium. A blister may be made 
in a few minutes by wetting paper with chloroform liniment 
or aqua ammonia, and applied smoothly to the surface. 

Next to the influence of opium in efficiency, is, probably, 
revulsion to the epigastrium by means of rubefacients or 
blisters. An elegant cataplasm for the purpose may be 
made with equal parts of powdered cinnamon, cloves, ginger, 
and pepper, incorporated by means of warm spirit and some 
adhesive substance, as honey or molasses. Flannels moist- 
ened with a decoction of Cayenne pepper in spirit, or w T ith 
the oil of horsemint or of turpentine, may also be used, 
although the unpleasant smell of the latter oil is an objec- 
tion to it. But the most effectual of the rubefacients is a 
sinapism made with pure mustard and water, which should 
be kept on from half an hour to an hour. When a strong 
and lasting impression is required, a blister should be re- 
sorted to. 

Lime-water and fresh milk, in the dose of a tablespoonful 
of each every half hour, hour, or two hours, is very useful 
in cases where there is not too much excitement, where 
some nutriment is required, and especially where the sto- 
mach rapidly creates acid. 



468 



FUNCTIONAL DERANGEMENTS. 



SICK-HEADACHE. 



This is very often essentially a gastric affection, and 
therefore may be considered in this place. 

Symptoms. — The pain in the head sometimes comes on 
abruptly, but is usually preceded by certain premonitory 
symptoms, such as confusion of head, vertigo, dulness, de- 
pression of spirits, irritability of temper, and perversion of 
hearing or sight, especially of the latter. The pain in the 
head is usually slight at first, and gradually increases until 
it becomes intense, but sometimes is violent from the outset. 
In the great majority of cases it is felt in the forehead, over 
the brow, or in the eye, sometimes only on one side, but 
generally on both, and not unfrequently the eyeballs are 
sore to the touch. In some instances the pain extends over 
the whole head, or is felt more especially in the back of the 
head or neck. It is often attended with chilliness, flushes 
of heat, and other deranged sensations ; but the pulse is 
almost always natural or nearly so in frequency, and thus 
at once serves to distinguish the case from an attack of fever. 
The tongue is in some instances slightly furred. After the 
pain has continued for some time, nausea occurs, by which 
it is somewhat relieved ; and there is often an alternation 
of severe headache and nausea for a considerable time, the 
latter gradually increasing, until at length vomiting takes 
place. The matters discharged are usually sour or bitter, 
but sometimes tasteless, especially if some antacid medicine 
has been taken. After vomiting freely, the patient usually 
falls asleep, and, having rested for several hours, awakes free 
from pain, or nearly so. Should a dull pain in the head 
remain, it generally disappears after a meal, or upon exer- 
cise in the open air. 

Causes. — In persons predisposed to sick-headache, slight 
causes are sufficient to induce an attack. It is brought on 
by the use of indigestible or acescent food, excess in eating 
or drinking, great bodily fatigue, loss of rest, extraordinary 
mental inquietude or exertion, exposure to cold when warm 
and perspiring, and by whatever else is capable of producing 
a morbid accumulation of acid in the stomach, or an excess- 



IRRITATION OF STOMACH. 469 

ive secretion of bile. The predisposition, for the most part, 
consists in debility of stomach, and a peculiar state of the 
nervous system, which renders the brain especially sensible 
to gastric irritation. Hence, all the causes of dyspepsia are 
predisposing causes of sick-headache. (See Dyspepsia.) 
It may be proper to mention here, as among the most pro- 
minent, the habitual use of coffee and tea, especially of the 
former. These nervous stimulants, when long and freely 
employed, have the indirect effect of diminishing the energy 
both of the stomach and brain, by the state of excitement 
which they produce in these organs ; and their operation 
often escapes notice, because their immediate effect is not 
unfrequently to relieve, for a time, the affection resulting 
from their habitual use. 

Treatment. — This must be considered in relation first to 
the paroxysm, and second to the interval. The attack may 
often be prevented by proper measures, applied upon the 
first appearance of the premonitory symptoms. The pre- 
vious experience of the patient will generally serve as an 
index to the nature of the offending cause. If this be acid 
in the stomach, as happens in the majority of cases, from 
half a drachm to a drachm of magnesia will be found 
among the most effectual preventives. If bile be the 
offending cause, some quick and gentle cathartic will be 
best adapted to the case ; as half an ounce or an ounce of 
epsom salts, one or two seidlitz powders, or a little infusion 
of senna. 

But if it is felt to be coming on, a full dose of opium 
should be given, and the patient should retire to bed, in a 
dark room, and keep as quiet as possible. He will thus 
sometimes fall asleep and awake much relieved, without 
vomiting. Bathing the temples and forehead with some 
aromatic spirit, as spirit of lavender or cologne water, some- 
times affords relief; but the speediest and most certain 
relief may be obtained by the use of chloroform liniment, 
or chloroform alone. 

In relation to the treatment in the intervals, little need be 
said here. All those measures are indicated which are 
calculated to strengthen at once the stomach and the nerv- 



470 FUNCTIONAL DERANGEMENTS. 

ous system. These have been fully treated of under dys- 
pepsia. Among them none is more important than the 
removal of the predisposing causes. It has been stated 
that the habitual use of coffee and tea, especially the former, 
is one of the most influential of these causes. I have re- 
peatedly known cures of sick-headache to be effected by an 
entire abstinence from coffee, where other means had failed ; 
and one striking instance occurs to me in which an indi- 
vidual, after suffering long and severely with the disease, 
obtained an entire exemption by refraining from the use of 
black tea, which was his only indulgence. We cannot, 
therefore, too strongly urge an abstinence first from coffee, 
and, if this should prove insufficient, from tea also, even 
from black tea. These beverages, as has been stated, often 
operate advantageously as remedies in the paroxysm ; but 
it is in consequence of those very properties which render 
their habitual use poisonous to some persons. Tobacco and 
alcoholic drinks, if habitually indulged in, should also be 
given up. 

In cases where the paroxysm returns at regular intervals, 
as sometimes happens, sulphate of quinine will often effect 
at least a temporary cure. The anodyne alterant (see Dys- 
pepsia) will be found to be a most excellent remedy in this 
disease ; but should the liver be obstinately torpid, a mer- 
curial pill, or a grain of calomel, should also be given every 
night, or every other night, followed by a laxative next 
morning, and continued till the evil is corrected. 

MORBID APPETITE. 

There are two forms of morbid appetite — one in which the 
desire for food is abnormally increased, the other in which 
it is directed towards unusual objects. In the former case, 
it is said to be voracious ; in the latter, perverted or depraved. 

Voracious Appetite — Voracity — Canine Appetite — Boulimia. 
— There are various degrees of this affection, from a slight 
increase beyond the point of health, to a constant and insa- 
tiable craving for food. Cases are on record in which the 
patient when awake was never content unless eating, and in 
which an almost incredible amount of food was consumed. 



IKMTATION OF STOMACH. 471 

Dr. Mortimer, in the 43d volume of the London Philosophi- 
cal Transactions, relates the case of a boy of about twelve 
years, who, in six successive days, took a quantity of dif- 
ferent kinds of food weighing three hundred and eighty- 
four pounds eight ounces, equal to about sixty-four pounds 
a day. In such cases, when food is withheld, there is a 
feeling of uneasiness, inquietude, or even faintness, with an 
indescribable vacuity or sinking of stomach, a sort of crav- 
ing void, which impels the patient to seize voraciously upon 
every thing in the shape of food, however unsuitable or 
ordinarily repulsive, and even to gnaw his own flesh if not 
indulged. Individuals with this propensity are usually 
thin and even emaciated ; although, in some instances, the 
food serves the purpose of an increased nutrition, and enor- 
mous obesity is the consequence. In cases of the former 
kind, the food is sometimes vomited, and sometimes passes 
quickly through the bowels, without undergoing digestion. 
Occasionally it is rapidly digested, and is converted into 
chyle and blood, but merely serves to supply materials for 
hemorrhage, or some excessive excretion, as that of per- 
spiration or urine. 

If it be considered that hunger is a sensation which, 
though always referred to the stomach, and often originat- 
ing in that organ, may be equally produced by impressions 
sent to the brain from the nutritive vessels all over the 
body, when in want of supplies for their proper function, it 
will be easily understood that voracious appetite may de- 
pend either upon a disordered condition of the stomach, or 
upon the state of the nutritive function in general. 

Little need be said upon the treatment of this affection. 
In cases arising from malformation of stomach, a cure is not 
to be expected. As a palliative, compression of the abdo- 
men by a tight band has been recommended. When the 
complaint depends upon any morbid state of the system or 
an organ, our remedies must be addressed to the primary 
disease. Direct irritation of the stomach must be com- 
bated in the modes already detailed. Perhaps, in some 
cases, advantage may be derived from sustaining nausea for 
a considerable time by means of emetic medicines in small 



472 FUNCTIONAL DERANGEMENTS. 

doses. In the excessive appetite which follows long fast- 
ing, and attends convalescence, it is often highly important 
to restrain the propensity; as much danger sometimes 
results from over-indulgence. In the gluttony of habit, on 
the contrary, there is danger from too sudden a withdrawal 
of food. The system sometimes sinks rapidly and unex- 
pectedly in such cases, as from the sudden withdrawal of 
stimulating drinks. Hence gluttons, like drunkards, are in 
peculiar danger from diseases which take away the appetite, 
and thus cut off the usual supply. The practical inference 
from this fact is, that any attempt to cure an established 
habit of over-eating should be gradual. 

Depraved Appetite — Pica.— In this affection there is a 
desire, often irresistible, for strange articles of food, for 
substances wholly unfit for food, and sometimes for things 
offensive or even disgusting. These whims of the appetite 
are exceedingly diversified, and there is scarcely any ob- 
ject in nature to which they may not be directed. Thus, 
instances are on record of persons having a propensity for 
spiders, toads, serpents, candles, paper, earthy matters of 
various kinds, as clay, chalk, and magnesia, and even hard, 
wounding bodies, as stones, pieces of glass, pins, needles, 
and blades of knives. Such vagaries are often temporary, 
and of little importance ; but they are sometimes durable, 
and cease only with the life of the individual, who falls a 
victim either to the disease of which the depraved appetite 
is merely a symptom, or to the chronic gastritis, and gene- 
ral disorder of health, which its indulgence produces. 

Like voracity, this affection may depend upon some form 
of gastric irritation, upon inscrutable changes in the inner- 
vation of the stomach, upon cerebral disorder amounting to 
a species of insanity, or upon mere habit. The form of 
depraved appetite which seeks indulgence in the eating of 
clay, chalk, etc., is probably connected with acid in the 
stomach, which is neutralized in the substance swallowed. 
It is possible that, in some of those cases in which hard, 
rough, or pointed bodies are swallowed, the propensity de- 
pends upon that insupportable feeling of vacuity in the 
stomach, which is relieved by the pain or excitement these 



DIARRHCEA. 473 

bodies may produce. Depraved appetite occurs most fre- 
quently in children, and in chlorotic, hysterical, or pregnant 
females. The whimsical fancies of pregnancy are univer- 
sally known. 

The general observations upon the treatment of voracious 
appetite are applicable here. To obviate, as far as possible, 
every observable disorder of function is the chief indica- 
tion. In cases strictly and exclusively stomachic, an 
emetic followed by cathartic, antacid, and tonic medicines, 
with wholesome digestible food, and the various other 
measures calculated to invigorate the stomach, are the 
remedies from which most advantage may be anticipated. — 
(See Dyspepsia.) 

DIARRHOEA. 

Those cases are denominated diarrhoea in which the alvine 
evacuations are more liquid, frequent, and copious than in 
health, without being hemorrhagic or dysenteric in their 
character. 

The affection is rather a consequence of certain patho- 
logical conditions than itself a disease. These conditions 
are various, and sometimes even opposite ; as is rendered 
obvious by a consideration of the different agencies which 
may produce increased evacuation from the bowels. A 
simple increase of the peristaltic action may have this effect, 
without the cooperation of any other cause. It may also 
result from an elevated excitability of the bowels, causing 
them to receive a stronger impression from their usual con- 
tents than in health, or from an increase in the quantity or 
stimulating quality of the ingesta acting upon the ordinary 
excitability, or from a condition of the digestive organs, 
allowing bland materials introduced into the stomach to 
undergo changes which may render them irritant. Again, 
irritation or inflammation of the intestinal mucous membrane 
may produce secretions which, from their quantity or 
quality, shall prove purgative; and in one portion of the 
alimentary canal, matters may be generated which shall 
operate in this way upon another portion farther down. 



474 FUNCTIONAL DERANGEMENTS. 

The biliary and pancreatic secretions, moreover, may be so 
altered as to excite the bowels to increased action, though 
the latter may be in perfect health. Finally, debility of 
the mucous membrane may allow the elimination of fluids, 
which, by mere distention of the bowel, shall cause the 
muscular coat to contract more rapidly. These are very 
different conditions, yet all attended with diarrhoea. The 
only common circumstance is increased peristaltic action. 

With this diversity in the sources of diarrhoea, there is 
an equal diversity in the attendant symptoms ; and there is 
scarcely any phenomenon common to all the varieties except 
those mentioned in the definition. The evacuations may be 
very few, not exceeding two or three daily, or so frequent 
that the patient scarcely satisfies one call before he expe- 
riences another. There is generally more or less pain 
before the evacuations, which are almost always followed 
by relief; but in some cases no pain whatever is experienced 
throughout. Along with the discharge is occasionally a 
very disagreeable sinking sensation in the abdomen, with a 
general feeling of exhaustion or faintness, a cool skin, and 
a feeble, irregular pulse. This condition, however, is almost 
always temporary. Diarrhoea is sometimes attended with 
fever, which is generally an indication of inflammation, or 
very high and extensive irritation of the mucous coat. But 
in the great majority of cases there is no fever. The 
skin is usually dry, and the urine scanty. Every possible 
diversity exists in the degree, duration, and danger of the 
complaint. It may be quite trivial, getting well in a day 
or two without aid, or may run on for months and even 
years, resisting every variety of treatment. Many such 
cases were found among the soldiers who returned from the 
Mexican war. In some rare cases, death occurs suddenly 
from great exhaustion, even w T hile the patient is on the 
stool. But more commonly, a fatal termination is preceded 
by a slow emaciation and gradual failure of strength. Very 
protracted and fatal cases are generally connected with 
tuberculous or cancerous lesions of the bowels, organic 
disease of the liver, or a scorbutic state of system. In 



DIARRHXEA. 475 

simple diarrhoea, whether acute or chronic, without organic 
lesion, the prognosis is almost always favorable, provided 
proper treatment can be applied. 

Treatment. — This must vary according to the character 
of the disease. In relation to the treatment of diarrhoea, 
the propriety of inspecting the evacuations cannot be too 
strongly urged. When the complaint depends simply upon 
increased peristaltic movement, it usually subsides with the 
cessation of the cause. Should it require treatment, from 
five to ten drops of laudanum, or a fluidrachm of the cam- 
phorated tincture of opium may be given, and repeated if 
necessary. In the crapulous form, the loaded bowels may 
be relieved by a dose of castor oil or other mild cathartic, 
and the diet afterwards reduced in quantity, and made to 
consist of materials which yield a comparatively small pro- 
portion of excrement, as meats, milk, and farinaceous sub- 
stances. 

The treatment for inflammatory diarrhoea has already 
been detailed. — (See Enteritis.) In diarrhoea of irritation, 
respect must be had to the cause. If slight, without disco- 
loration of the passages, without febrile excitement, and 
with little or no griping, the case will in general require 
scarcely any thing more than a regulation of the diet. If 
the presence of irritant substances in the bowels is sus- 
pected, a dose of castor oil should be given with or without 
laudanum, according as the pain is considerable or other- 
wise. When the stools are green or of a sour smell, or 
other evidence of acid in the stomach is presented, mag- 
nesia, or a mixture of this with rhubarb, should be substi- 
tuted for the oil. Purging, however, has been abused in 
this complaint. It should not be carried farther than is 
necessary to meet the indication above presented. In some 
rare cases, collections of feculent or foreign matters in the 
bowels, somewhat difficult to dislodge, sustain a vexatious 
diarrhoea, which can be removed only by a removal of the 
cause. In such cases, the cathartics already mentioned 
may be repeated, or others more active resorted to. When 
worms are the offending cause, calomel is the most efficient 
cathartic, and should be given in connection with vermifuge 



476 FUNCTIONAL DERANGEMENTS. 

medicines. These cases, however, are rare ; and, in general, 
a single dose of the cathartic is sufficient. In cases not 
requiring laxatives, and in others, after the proper use of 
these medicines, opiates are the most efficient remedies. If 
the irritation be moderate, and wholly unattended with 
arterial excitement, from five to ten drops of laudanum, 
with or without a little camphor water, or a fluidrachm of 
camphorated tincture of opium, repeated two or three times 
a day, will generally arrest the disease. When acid con- 
tinues to be generated, prepared chalk or prepared oyster- 
shell should be added to the anodyne ; or, if there should 
be a slight febrile action, carbonate or bicarbonate of soda 
or potassa should be substituted ; or equal quantities of 
salts and soda, given in broken doses, will be still better. 
If by these means the discharge is not arrested, and the 
patient complains of little or no pain, one of the vegetable 
astringents may be added, such as logwood, kino, catechu, 
rhatany, geranium, or pure tannic acid. 

In the form of diarrhoea attended with white passages, 
it is often highly important to stimulate the liver as speedily 
as possible. When the stools are small, and the patient 
not materially weakened, from five to ten grains of calomel 
may be given at once. In children two or three years old, 
one or two grains of calomel may be given every two hours 
until it produces some effect on the bowels, care being 
taken not to exceed four or six grains. The happiest effects 
sometimes immediately result. But if the passages are 
somewhat copious, or the patient feeble, the calomel should 
be given with opium or paregoric, and followed by some pre- 
paration of rhubarb, or a little castor oil, if the bowels 
should be confined. The alterative plan may afterwards be 
followed by giving smaller doses of the mercurial with 
opium or Dover's powder. When the evacuations are 
alarmingly copious and exhausting, I have found great 
advantage from small and frequent closes of hyd. cum 
creta, or blue powder, say three grains every hour, given in 
a teaspoonful of the anodyne carminative, or in fever syrup, 
or mucilage. 

In diarrhoea of debility, in which may be included most 



DIARRHCEA. 477 

cases of chronic diarrhoea not attended with pain or fever, 
after correcting the biliary secretion if deranged, we may 
resort to astringents and tonics, of which a vast variety 
have been recommended. Among the vegetable astrin- 
gents, may be enumerated, besides those already mentioned, 
galls, oak bark, blackberry and dewberry root, black alder, 
alum root, pomegranate, etc.; among the tonics, columbo, 
gentian, quassia, simaruba, angustura, cascarilla, etc. These 
may be tried, separate or variously combined, in decoction 
or infusion, flavored with cinnamon or orange peel, and with 
some hope of advantage. But, on the whole, more good 
may be expected from the mineral substances belonging to 
the same classes, especially alum, acetate of lead, sulphate 
of copper, sulphate of zinc, nitrate of silver, and the vari- 
ous chalybeates ; but the fever syrup, taken after meals, 
will generally prove of more advantage than any other 
remedy. When stimulation is requisite, good port wine 
should be preferred. For the treatment especially applica- 
ble to the diarrhoea of chronic enteritis, the reader is re- 
ferred to that disease. 

There are various accessory measures which may be 
resorted to, in any of the %rms of diarrhoea. Of these the 
warm bath, in acute cases when the skin is warm and dry; 
the hot bath, and especially the warm salt-bath, in chronic 
cases when it is cool and pale, are perhaps the most efficient. 
They may be used with great advantage in the cases of 
children. A bath of decoction of oak bark has been recom- 
mended in similar cases. Much benefit may also be 
expected from a flannel bandage about the body. Frictions 
to the surface are decidedly useful, when the cutaneous 
circulation is languid, and rubefacients or blisters to the 
abdomen may be tried in obstinate cases. Anodyne ene- 
mata are sometimes highly serviceable in allaying the intes- 
tinal irritation. Warm clothing, with flannel next the skin, 
is important. This precaution is too often neglected in 
children, whose feet, legs, and arms are apt to be exposed 
unprotected to the changes of temperature, which they are 
less able to bear than adults. Regular exercise should not 



478 FUNCTIONAL DERANGEMENTS. 

be neglected in chronic cases, when the patient is in a situ- 
ation to take it. 

Diet. — Attention to diet is indispensable. In many cases, 
indeed, no other remedial measure is necessary, especially 
when the disease has originated from improper food. In 
infantile diarrhoea, it is important to ascertain whether the 
milk of the nurse is healthy, and, if there is reason to sus- 
pect that it is otherwise, to substitute another nurse, or to 
remove the child from the breast altogether. The farina- 
ceous substances, such as stale or toasted bread, water- 
crackers, and boiled rice, constitute a suitable diet in the 
early stages of diarrhoea of irritation. Milk is admissible 
in mild cases. Farinaceous drinks may be employed when 
the irritation is considerable, and especially when the 
stomach participates in it. Fresh vegetables and fruits 
should, as a general rule, be avoided. Whatever is eaten 
should be thoroughly masticated. For infants, fresh milk, 
diluted with water, and thickened with arrow-root or pul- 
verized water-crackers, constitutes a good diet; but, when 
there is fever or evidence of inflammation, the food should 
consist exclusively of mucilaginous or farinaceous liquids. 
In the more advanced stages, milk, broths, and boiled meats, 
with fresh butter and cream, may be allowed; and in 
diarrhoea of debility, this kind of food should be given from 
the commencement. In many chronic cases, an exclusive 
milk diet will often alone effect cures. The dietetic rules 
applicable to dyspepsia should be observed during convales- 
cence. (See Dyspepsia.) 

COLIC. 

Colic is characterized by pain in the bowels, usually more 
or less paroxysmal in its character, associated with consti- 
pation, and occurring independently of inflammation either 
of the mucous or peritoneal coat. Pathological conditions 
essentially different are included in the above definition; 
hence writers usually enumerate many varieties of colic, as 
cramp, bilious, flatulent, lead, etc., out all depend upon 
spasm, without which there can be no colic; and, as the 




i. The Upper Lip, turned off the Mouth. 

2. Its Frasnum. 

3. The Lower Lip, turned down. 

4. Its Fraenum. 

5.5. Inside of the Cheeks, covered by the lining 
Membrane of the Mouth. 

6. Points to the opening of the Duct of Steno. 

7. Roof of the Mouth. 

8. Lateral Half Arches. 

9. Points to the Tonsils. 

10. Velum Pendulum Palati. 

11. Surface of the Tongue. 

12. Papillae near its point. 

13. A portion of the Trachea. 

14. The GEsophagus, (gullet.) 
Its internal surface. 
Inside of the Stomach. 
Its greater extremity or great Cul-de-Sac. 
Its lesser extremity or smaller Cul-de-Sac. 
Its lesser Curvature. 
Its greater Curvature. 
The Cardiac Orifice. 
The Pyloric Orifice. 
Upper portion of Duodenum. 

24.25. The remainder of the Duodenum. 

26. Its Valvulae Conniventes. 

27. The Gall Bladder. 

28. The Cystic Duct. 

29. Division of Hepatic Ducts in the Liver. 

30. Hepatic Duct. 
Ductus Communis Choledochus. 
Its opening into the Duodenum. 
Ductus Wirsungii, or Pancreatic Duct 
Its opening into the Duodenum. 

35. Upper part of Jejunum 

36. The Ileum. 

37. Some of the Valvulae Conniventus. 

38. Lower extremity of the Ileum. 

39. Ileo-Colic Valve. 

40.41. Ccecum, or Caput Coli. 
42. Appendicula Vermiformis. 
43.44. Ascending Colon. 
45. Transverse Colon. 
46.47. Descending Colon. 

48. Sigmoid Flexure of the Colon. 

49. Upper portion of the Rectum. 

50. Its lower Extremity. 

51. Portion of the Levator Am Muscle. 

52. The Anus. 



A VIEW OF THE ORGANS OF DIGESTION, OPENED IN NEARLY THEIR 

WHOLE LENGTH. 

A portion of the GEsophagus, (gullet,) has been removed on account of want of space in the figure; 
the arrows indicate the course of substances alone the canal. 



*5- 
16. 

*7- 



19. 
20. 



23- 



3i- 
32. 

33- 
34- 



colic. 479 

prominent symptoms and the treatment are the same in all, 
these distinctions become unnecessary. 

Symptoms. — The pain of colic occurs usually in fre- 
quently returning paroxysms, with irregular remissions or 
intermissions ; but, in some instances, is continued and 
almost uniform, for considerable periods. During the exa- 
cerbation, it is often exceedingly severe, so as to cause even 
persons of fortitude to groan or cry out. It occurs most 
commonly about the umbilicus, though not unfrequently in 
other parts, and sometimes over the whole abdomen. It is 
described as twisting, rending, pinching, etc., and is often 
attended with a feeling of spasmodic constriction. The 
patient is for the most part extremely restless, frequently 
changing his position, turning from one side to the other, 
sitting up in bed, or rising and walking about the room with 
his body bent, and his hands frequently pressed against the 
abdomen. The muscles of the abdomen are sometimes 
spasmodically contracted, either in knots, or so as to pro- 
duce a general rigidity of the anterior parietes. The vio- 
lence of the pain occasionally depresses temporarily all the 
vital actions, producing paleness of the skin, cold sweats, a 
shrunken countenance, and a feeble pulse. When very 
sudden in its attack, it may produce faintness, and even 
temporary insensibility, and in infants frequently occasions 
general convulsions. It is often relieved by pressure on 
the abdomen, but not uniformly so. When the violent pain 
has ceased, a feeling of soreness is generally left behind. 

The pain, in true colic, is always accompanied with con- 
stipation either as cause or effect ; and when this is over- 
come by medicines, not unfrequently ceases. In certain 
cases, however, it continues without abatement, notwith- 
standing the operation of cathartics. 

Along with the pain and constipation there is often vom- 
iting, but this is by no means constantly present. The 
stomach occasionally participates with the bowels in the 
spasmodic pain. The pulse is generally either healthy, or 
somewhat depressed. Occasionally, however, the disease 
is originally associated with inflammation, or this condition 
ensues in the course of it, or there is high irritation in some 
31 



480 FUNCTIONAL DERANGEMENTS. 

neighboring organ. Under these circumstances, a febrile 
condition may be developed. 

Colic, in the great majority of cases, yields readily to 
suitable treatment. Tn some instances, however, the con- 
stipation persists and the disease assumes the most alarm- 
ing character, in spite of all that can be done. The vomit- 
ing is now frequent, every thing taken into the stomach is 
rejected, the action of the bowels themselves is inverted, 
and even feculent matter is discharged from the mouth. 
Along with these symptoms, are a swollen, tense, and tym- 
panitic abdomen, hiccough, great anxiety, cold sweats, a 
feeble pulse, and a general expression of the last degree of 
prostration. This condition is denominated ileus or the 
iliac passion, and is frequently, though upon insufficient 
grounds, treated of as a distinct disease. It is the closing 
stage of the severest forms of colic, and is often connected 
with some irremovable mechanical obstruction. It may 
occur, in fact, in any case in which, no matter from what 
cause, whether spasm, or partial paralysis of the bowel, or 
obstruction, the alvine contents cannot find their way down- 
ward. Even ileus, however, is not always certainly fatal. 
Patients have in numerous instances recovered under 
apparently desperate circumstances ; and hope and conse- 
quent efforts should never be abandoned, unless when some 
insuperable obstacle, such as a cancerous closing of the 
bowel, is known to exist. 

Colic has no fixed duration, sometimes terminating in a 
few hours, and sometimes running on for two or three 
weeks. 

Diagnosis. — The complaint with which colic is most likely 
to be confounded is strangulated hernia. In fact, the only 
difference between this and some forms of colic depending 
on mechanical obstruction, is that the former presents cer- 
tain external characters by w T hich it can be recognized, and 
may be relieved by the timely application of surgical 
means. But this distinction is of the highest importance, 
and the possible existence of strangulated hernia should be 
borne in mind, in every case of severe or obstinate colic, 
and a close examination instituted. Many lives have been 



colic. 481 

lost from want of attention to this caution. From mucous 
enteritis colic may be distinguished by the constipation 
which attends it ; from both this and peritonitis, by the 
more paroxysmal character of the pain, by the relief fre- 
quently derived from pressure, by the absence of fever, and 
by the restless movements of the patient. 

The objects to be obtained in the treatment of colic are, 
to relieve pain and move the bowels. 

When the pains are moderate, and dependent upon flatu- 
lence or mere exposure to cold, without the presence of irri- 
tating solid or fluid matter in the bowels, relief may often 
be quickly obtained by the exhibition of moderate stimu- 
lants, especially of those which are rather local than general 
in their action, such as the aromatic oils, infusions, and 
tinctures. A cupful of hot infusion of ginger, cloves, or 
calamus ; from fifteen to thirty drops of the essence of pep- 
permint or spearmint, dropped on sugar, or diffused in 
sweetened water ; or from one to four teaspoonfuls of pare- 
goric or Bateman's drops, will usually be found efficient. 
When the complaint has originated in exposure to cold, the 
feet may be soaked in hot water, or held before a hot fire ; 
and this simple remedy will often give relief without other 
means. 

In severe cases of the same kind, or in such as have 
resisted the above treatment, a full dose of opium or some 
one of its preparations should be given, and repeated at in- 
•tervals of one, two, three, or four hours, according to the 
urgency of the symptoms, until the pain is moderated, or 
decided narcotic effects are experienced. The above-men- 
tioned aromatics, or even more powerful stimulants, may be 
advantageously associated with the opiate, especially when 
the system sinks under the severity of the pain. Under 
these circumstances, laudanum may be given with tincture 
of camphor, oil of turpentine, oil of juniper, aromatic spirit 
of ammonia, sulphuric ether, or even musk, when the sto- 
mach is the seat of the spasm. In cases complicated with 
hysteria, infusion of valerian, or tincture of assafoetida, may 
be given with the stimulants mentioned. 

The anodyne and stimulating remedies should be accom- 



482 FUNCTIONAL DERANGEMENTS. 

panied, or soon followed, by some quick cathartic, especially 
castor oil, which is, beyond a]l others, adapted to these 
cases. A fluidounce of the oil, with twenty-five or thirty 
drops of laudanum, given in peppermint water, will very 
often effectively meet all the indications. 

At the same time, external means should not be neglected. 
The chloroform liniment is the best, and will often alone 
relieve the disease at once ; but other means may also be 
used. Strong friction over the abdomen sometimes proves 
very serviceable, by aiding in the expulsion of flatus. 
Warm fomentations, anodyne and emollient cataplasms, and, 
in urgent cases, hot oil of turpentine, applied by means of 
a folded flannel moistened with it, and even a large sinapism 
over the abdomen, may also be employed. 

When the pain arises from irritating matter in the sto- 
mach, which may be inferred to be the case if the attack 
commence soon after eating, or if the patient be affected 
with nausea or retching in the intervals of the spasm, full 
vomiting should be promptly induced, either by copious 
draughts of warm water or warm chamomile tea, or by an 
emetic dose of ipecacuanha or mustard water. The most 
violent and threatening cases sometimes yield immediately 
to this simple remedy, after powerful anodynes and stimu- 
lants have been employed without effect. The attention of 
the reader cannot be too strongly directed to this fact. 

If there be reason to suppose that undigested food, acrid 
secretions, feculent accumulations, or any other irritating 
substance in the bowels, are the cause of the spasm, the 
indication for alvine evacuation is still stronger than in other 
cases, and this should be kept prominently in view. Should 
castor oil not act speedily, or be rejected from the stomach, 
recourse may be had to the infusion of senna with epsom 
salts. When the stomach is very irritable, calomel is often 
preferable to other cathartics, being retained when almost 
every thing else is rejected. Whatever purgative is used 
should be given in a full dose, and then nothing else swal- 
lowed for some time. If the irritating matter in the sto- 
mach or bowels be acid, magnesia should either be substituted 
for the other cathartics, or given in conjunction with them j 



CONSTIPATION. 483 

and it has been observed that mild laxatives of this charac- 
ter sometimes operate, when more powerful purgatives serve 
merely to increase the spasmodic constriction, and to pro- 
voke vomiting. A good laxative mixture for the purpose 
consists of magnesia and manna, mixed with strong fennel- 
seed tea. I have several times succeeded in stopping the 
vomiting, and moving the bowels, after all the usual remedies 
had failed, by giving the most oily portion of ken broth, 
highly seasoned with salt and black pepper. 

To hasten the action of the cathartics, or to supply their 
place when they are rejected from the stomach, or from 
other cause fail to operate, purgative enemata are of the 
utmost importance. Indeed, in some very bad cases, they 
constitute our chief reliance. The milder should be first 
employed, and afterwards, if necessary, the more powerful, 
their strength being increased at each successive repetition. 
After failure with the common injection, consisting of olive 
oil or lard, common salt, and molasses, of each a tablespoon- 
ful, mixed with a pint of warm water; the operator may 
resort successively to castor oil, infusion of senna, jalap, 
extract of colocynth, etc., each in three or four times the 
quantity usually given by the mouth, and diluted with 
water so as to measure a pint or more. Oil of turpentine, 
in the quantity of from half a fluidounce to two fluidounces, 
mixed with half a pint or a pint of water by the interven- 
tion of the yolk of eggs, forms an excellent enema in severe 
cases. When the spasm is dependent on flatulence, or con- 
nected with hysterical disorder, the greatest advantage may 
be expected from a drachm of assafoetida rubbed up with 
water. 

CONSTIPATION. 

By this term is indicated a condition of the bowels in 
which the stools are less frequent or less in quantity than 
in health. Cases in which the intestines are entirely closed 
against the passage of faeces, in consequence of some me- 
chanical impediment, are treated of under the head of 
obstruction. 

Symptoms. — In deciding as to the existence of constipa- 



484 FUNCTIONAL DERANGEMENTS. 

tion in any particular case, it is necessary to take into con- 
sideration the interval at which the alvine evacuations 
habitually occur, in the healthy state of the individual. 
Most persons have one passage in each period of twenty-four 
hours ; but some have two or more daily, others only one 
every third or fourth day, and instances are occasionally 
met with in which the interval is extended to one or even 
two weeks, without apparent disadvantage. It is probable, 
however, that, in these latter cases, a close examination 
would discover derangements sufficient to prove that the 
long suspension of the evacuations was any thing but a 
healthy state of the function. In general, constipation may 
be said to exist when the passages occur less frequently 
than once a day. But a person may be very seriously con- 
stipated, notwithstanding that his evacuations are quite reg- 
ular in the period of their recurrence, if they be of insuffi- 
cient quantity. It not unfrequently happens that a portion 
of the feculent matter which ought to be discharged at each 
stool is retained, and an accumulation thus insensibly takes 
place, which at length becomes manifest by the great incon- 
venience it occasions. 

The faeces in constipation are usually harder and dryer 
than in health, and not unfrequently come away in knotty 
lumps, with much straining and a painful distention of the 
anus. These lumps are occasionally covered with a white 
or bloody mucus, and are of different color, sometimes natu- 
ral, sometimes blackish, and sometimes light or clay-colored, 
indicating a deficiency or total absence of bile. When not 
pointed out by the diminished number or apparent condition 
of the stools, the affection may be suspected to exist, if the 
patient complain of a sense of weight or oppression in the 
abdomen or at the fundament, a frequent but ineffectual 
disposition to go to stool, flatulence, colicky pains, distention 
of the abdomen, and nausea with or without vomiting. 
Attention to these points is the more important, as in some 
cases of great fecal accumulation, whether in the rectum or 
higher up in the colon, the irritation of the bowel gives rise 
to occasional mucous discharges, tinged with fecal matter, 
and having a very offensive fecal odor ; or small quantities 



CONSTIPATION. 485 

of the liquid contents of the bowels are forced around the 
mass, or through an opening existing in it, and discharged 
per anum, so as to simulate diarrhoea. Such a condition is 
peculiarly apt to occur in old people, and has not unfre- 
quently been treated as diarrhoea, to the great detriment of 
the patient. If attended by the above symptoms, or some 
of them, constipation should be suspected, and a close ex- 
amination instituted. If the feculent mass be lodged in the 
rectum, it will at once be detected by introducing the finger 
through the anus ; if in the colon, it will often be obvious 
in the form of a hard tumor or tumors in the abdomen. 
There is reason to believe that such masses have not unfre- 
quently been mistaken for organized tumors. The impossi- 
bility of introducing an injecting pipe far into the rectum, 
or the great resistance made to the entrance of liquids 
through the instrument, often leads to the detection of these 
accumulations. The quantity of feculent matter which has 
sometimes accumulated in constipation is enormous. A case 
is recorded in the Archives generates, (iv. 410,) in which 
thirteen and a half pounds were found in the intestines. 
The length of time, also, during which patients sometimes 
sustain a complete want of alvine dejections is astonishing. 
From one to two weeks is no uncommon period, in the ex- 
perience of most practitioners, and cases are on record in 
which the patient has survived months of suffering from 
this cause. But, in most of these cases, the dejection per 
anum has been replaced by a vomiting of faeces, so as to 
prevent a fatal distention. Generally speaking, should the 
constipation not yield to appropriate treatment, symptoms 
of an alarming character come on in the course of a few 
days, and the case ends fatally, after a longer or shorter 
period of much and various suffering, with occasional re- 
missions and exacerbations, as temporary relief is obtained 
from vomiting. 

Causes. — -Constipation is either occasional, arising from 
some temporary cause, or protracted and habitual. Tn both 
cases, its pathological condition must consist in either, 1, a 
mechanical impediment to the passage of the alvine contents 
along the bowels ; 2 ; a diminished contractility of the mus- 



486 FUNCTIONAL DERANGEMENTS. 

cular coat, or a diminished susceptibility of the intestines 
to the influence of the usual alvine stimuli ; 3, a deficient 
supply of these stimuli; or, 4, a combination of two or 
more of the conditions mentioned. The causes of the affec- 
tion must, therefore, be such as are capable of inducing these 
conditions. 

Among those which occasion mechanical impediment, are 
solid masses formed out of the ingesta, or by precipitation 
from the intestinal liquids ; spasmodic or permanent stricture 
of the bowels ; the encroachment of variously organized 
tumors upon their calibre ; and strangulation of the intes- 
tines, as in hernia, intussusceptio, and twisting of some 
portion of the tube. These will be more particularly con- 
sidered under obstruction of the bowels. 

The causes which impair the contractility or susceptibility 
of the bowels, or both, are of more importance in relation 
to our present subject. These operate more especially upon 
the colon, though their influence is also felt throughout the 
intestinal tube. Torpor of the colon is one of the most 
common conditions in habitual constipation. Unable to con- 
tract sufficiently on the feculent matter, or unduly insensible 
to its presence, the bowel becomes distended by the accu- 
mulation which takes place, and, under the distention, 
suffers a still further diminution of its power and sensibility. 
The causes of this condition are numerous. They are, for 
the most part, the same as those which produce the analo- 
gous condition of the stomach existing in dyspepsia; as 
sedentary habits, excessive mental occupation, sensual in- 
dulgence of all kinds, morbid diversion of the blood and 
nervous energy to other organs, the use of narcotics and 
especially of opium, diseased conditions of the brain and 
spinal marrow, and, in fine, whatever debilitates the system 
generally, and consequently involves the bowels. Old age 
is attended with a diminished susceptibility of the aliment- 
ary canal, and is therefore very subject to constipation. 
Habit also has a powerful influence, and is indeed one of the 
most frequent causes of the complaint. By means of our 
control over the sphincter ani, we are endowed, to a consid- 
erable extent, with the power of regulating the alvine dis- 



CONSTIPATION. 487 

charges, and of resisting the solicitations of nature at 
inconvenient seasons. This power is too apt to be frequently 
exercised, and especially by females. The bowel is thus 
habituated to the presence of the feculent matter, feels less 
and less its wholesome stimulation, and at length ceases to 
be excited into action. Habitual constipation is a necessary 
result. The preparations of lead have a directly paralyzing 
effect upon the bowels ; and obstinate costiveness is there- 
fore an almost uniform attendant on colica pictonum, or lead 
colic. 

Of the causes which impair the stimulant properties of 
the intestinal liquids, the most common is perhaps a 
diminished or suspended secretion of bile, or any thing 
which impedes its access to the bowels ; the bile being one 
of the most energetic alvine stimulants provided by nature. 
Hence the frequent deficiency of the bilious color in the 
evacuations. The same may possibly be true to a certain 
extent of the pancreatic liquor, and is certainly so of the 
intestinal mucous and serous secretions. Hence the influ- 
ence of excessive discharges from other organs, as from the 
skin and kidneys, in producing costiveness. Hence, too, 
the action of astringents, which diminish or arrest the 
intestinal secretion. 

Many of the causes above enumerated operate doubly, 
impairing the contractility and sensibility of the bowel, 
while they diminish the amount of healthy stimulus by 
checking secretion. Such especially are those which act 
through the medium of the brain and spinal marrow. 
Excessive exercise often produces this effect by directing 
the energies of the system to other parts. A disposition to 
constipation is a very common attendant upon a long and 
fatiguing journey. 

Treatment. — Occasional attacks of constipation must be 
met by cathartics, proportionate in their activity to the 
difficulties of the case ; the milder being first employed, 
under ordinary circumstances, and the more energetic 
resorted to after these have failed. Castor oil is, from its 
combination of mildness with quickness and efficiency, one 
of those best adapted to ordinary cases. Sulphate of mag- 



488 FUNCTIONAL DERANGEMENTS. 

nesia and the other saline cathartics may also be used, and 
are especially applicable to solid fecal accumulations, in 
consequence of the copious serous secretion they induce, 
which penetrates and breaks down the impacted mass. 
Senna tea combined with the salt adds to its efficiency by 
the energetic influence which this cathartic exercises upon 
the muscular coat. 

Should the purgative not operate in due time, it should 
be aided by enemata, which sometimes become indispensable 
in consequence of an irritability of stomach which precludes 
the use of most cathartics by the mouth. The reader is 
referred to the article on Colic for an account of the sub- 
stances which may be used in this form. Perhaps, upon 
the whole, the most safe and at the same time efficient, in 
cases of great obstinacy, is weak or mild soapsuds thrown 
up the bowel in very large quantities by means of a self- 
injecting apparatus, and repeated so as gradually to soften 
and wash away the feculent matter. Any desirable quantity 
may thus be introduced into the bowels, if care be taken, 
by twisting a towel round the pipe and pressing it against 
the fundament, to aid the contractile power of the sphincter. 
Advantage may occasionally result from introducing the 
water directly into the colon through a long gum-elastic 
tube, passed high up into that bowel. When the faeces are 
impacted in the rectum, the assistance of the finger, a 
scoop, spoon-handle, or some similar instrument, introduced 
per anum, becomes necessary to break up and discharge the 
solid mass. Other measures may be employed in aid of 
those mentioned, as friction over the abdomen, warm vapor 
to the fundament, and the application of cold externally, 
either by ice to the palms of the hands and soles of the 
feet, or by a stream of cold water allowed to fall upon the 
abdomen. Spasmodic stricture of the bowels has some- 
times given way under this latter measure, after resisting 
purgatives and enemata. 

In habitual constipation, a somewhat different course must 
be pursued. Attention must here be especially paid to the 
removal of the cause. Efforts should be made by the 
patient to establish the habit of regular evacuations by 



CONSTIPATION. 4S9 

daily attendance at the privy, though it is important that 
he should avoid severe straining, which often gives rise to 
hemorrhoids or prolapsus ani. Moderate exercise, regular 
habits of life, relaxation from intense mental occupation, 
change of air and of scene, all have a favorable effect by 
contributing to the restoration of tone to the bowel. Fric- 
tions over the whole surface of the body, and the occasional 
use of the cold or shower-bath, contribute to the same end ; 
and whenever the excess of any function may be found to 
divert the due supply of vital energy from the colon, this 
excess should if possible be corrected. The use of all 
narcotic substances, including green tea and coffee, should 
be abandoned when there is reason to believe that the com- 
plaint depends on torpor of the intestines. 

The regulation of the diet is highly important, and this 
alone will frequently be sufficient to restore the proper 
action of the bowels. The food should in general be easily 
digestible, and such as is not calculated to yield a large 
amount of feculent residue. — (See Dyspepsia.) An exception 
to this rule may sometimes be made in favor of substances 
having laxative properties ; but discrimination is necessary. 
Laxative articles of diet are apt to be of difficult solubility 
in the stomach, and are not all adapted to a dyspeptic state 
of that organ. Such as are of this character should there- 
fore be avoided, or used cautiously, in constipation asso- 
ciated with dyspepsia. Bran bread, however, or some 
other preparation of wheat flour containing bran, may often 
be employed with great advantage in this case. When the 
stomach is not dyspeptic, fresh and dried fruits are highly 
useful. Indeed, it is not uncommon for persons disposed to 
costiveness to be entirely free from this condition at those 
times of the year when fruits are in season. The different 
edible berries, peaches, pears, apples, melons, etc., may be 
taken as freely as the stomach will admit without incon- 
venience ; and tomatoes, used as a vegetable at dinner, have 
been found highly beneficial even by dyspeptic persons. In 
the winter, the imported fresh fruits, such as grapes and 
oranges, and the dried fruits, such as dried peaches, prunes, 
figs, etc., may be substituted. Other laxative articles of 



490 FUNCTIONAL DERANGEMENTS. 

diet applicable to cases in which the digestion is vigorous 
are brown sugar, molasses from the plantations, hone}^ olive 
oil, rye or Indian meal in the form of mush, eaten with 
molasses, etc. Broths are sometimes preferable under similar 
circumstances to solid food. An exclusive diet of milk has 
sometimes appeared to produce very obstinate constipation, 
and this fact should be attended to in the treatment of 
children. 

When constipation is found to be connected with deficient 
secretion of bile, a calomel purge may be given at first, and 
afterwards the anodyne alterant {see Dyspepsia) given in 
tablespoonful doses after each meal, and assisted, if neces- 
sary, by a teaspoonful of salts, or one or two seidlitz 
powders, in the interval. Active purgatives should never 
be habitually given, as they further impair the sensibility 
of the bowels. 

Sulphur is adapted to cases as well of feeble as of 
vigorous digestion, and, as it produces unirritating passages, 
may be usefully employed in piles. In consequence of its 
alterative properties, it is an excellent laxative in the 
costiveness of rheumatic and gouty individuals. It is often 
associated with magnesia in dyspeptic cases, and with cream 
of tartar in inflammatory piles. Its disadvantages are that 
it is apt to occasion griping, and in time imparts odor to the 
breath and secretions. 

Some have employed enemata or suppositories as substi- 
tutes for cathartics by the mouth, administering them daily, 
or every other day, for a long time together. The mildest 
substances should be selected; as flaxseed tea or other 
mucilaginous liquid for injection, and hard soap or solidified 
molasses for introduction in the solid form. But both are 
liable to the objection that they concentrate in one part of 
the bowels the irritation which the laxative medicine 
spreads, in a comparatively diluted state, over their whole 
track, while they do not so effectually evacuate the upper 
portions of the canal. 

But laxatives either by the mouth or rectum should be 
employed only as adjuvants to a properly regulated 
regimen, and should be suspended the moment that they 



OBSTRUCTION OF THE BOWELS. 491 

are no longer necessary. Care should also be taken to 
administer them in doses no larger than is essential to the 
end desired. 

They should always be given on an empty stomach, as 
they thus operate more speedily and with less uneasiness. 
Half an hour or an hour before breakfast, an hour or two 
before dinner, and at bedtime without previous supper, 
are the proper periods. Given at bedtime, they will not 
act until morning, and the patient will experience little or 
no inconvenience during the night ; while he thus escapes 
the annoyance and inconvenience of their operation during 
the day. This, therefore, upon the whole, is the most 
appropriate time. 

Various other measures have been employed in habitual 
costiveness. The smoking of tobacco has in some persons 
been found to obviate constipation, though in others it 
occasions it when used in excess, by impairing the sensi- 
bility of the digestive tube. Friction to the abdomen with 
rubefacients, coarse flannel, or the flesh-brush ; tepid or cold 
affusion upon the loins ; and leeches or cups to the spine 
when the constipation may be supposed to have its origin 
in disorder of the medulla spinalis, or spinal marrow, have 
been recommended. 

OBSTRUCTION OF THE BOWELS. 

This term, as here employed, implies the existence of 
some mechanical impediment to the passage of the contents 
of the bowels. The obstruction sometimes comes on slowly, 
with the ordinary symptoms of constipation, the patient 
experiencing gradually increasing difficulty in obtaining 
evacuations, until they cease. In many instances, however, 
the attack is sudden and altogether unexpected. It often 
happens that, for a few days after the cessation of dis- 
charges, no great inconvenience is felt ; but sooner or later, 
and sometimes immediately, the patient begins to complain 
of uneasiness in the abdomen, attended frequently with a 
desire to go to stool, and bearing down efforts which are 
either quite ineffectual, or produce only slight, bloody, 
mucous or feculent passages, without affording relief, 



492 FUNCTIONAL DERANGEMENTS. 

♦ 

Cathartics axe taken without effect, and enemata, after 
evacuating occasionally small quantities of fecal matter, 
come away as administered. The discharges which thus 
occur spontaneously, or are obtained artificially, consist 
only of matters contained in the bowels below the point of 
obstruction ; and care should be taken that they do not lead 
to false inferences as to the nature of the affection. Dis- 
tention of the abdomen now comes on, with flatulent eruc- 
tation, severe spasmodic pain, great restlessness and anxiety, 
and at length nausea and vomiting, so that substances taken 
into the stomach are instantly rejected, and medicines can- 
not be retained. Symptoms of inflammation, as tenderness 
upon pressure, a quick pulse, and furred tongue, are often 
mingled with those of obstruction. Should relief not be 
obtained, troublesome hiccough occurs ; the vomiting not 
unfrequently assumes a stercoraceous or bloody character ; 
disury, with deep red urine, is added to the olher symptoms ; 
the belly becomes enormously distended and tympanitic, 
the respiration oppressed, the face bathed in sweat, the 
skin pale and clammy, the extremities cold, the pulse 
exceedingly feeble, and the countenance haggard ; and the 
patient sinks, completely worn out and exhausted, death 
being frequently preceded by delirium. This, however, is 
not the uniform result. The vomiting of faeces sometimes 
affords temporary relief; the worst symptoms disappear, to 
occur again when the bowels become again loaded ; or the 
obstruction may be partially removed by an effort of 
nature, and again return; and a course of suffering and 
exhaustion, alternating with partial relief and re'action, may 
continue for months, or even years, ending at last in death, 
or in a complete removal of the obstruction, and recovery. 

In cases presenting the above symptoms, a close exami- 
nation of the abdomen should be made, in order to ascertain 
whether the cause of the phenomena may not be strangu- 
lated hernia. There is reason to think that death his 
frequently occurred from a neglect of this precaution 

Dissection after death exhibits the intestine very much 
distended — in some instances enormously so — above the 
place of obstruction. Marks of inflammation are frequently 



OBSTRUCTION OF THE BOWELS. 493 

observed, and sometimes those of gangrene. According to 
Burne, when the obstruction depends upon a purely me- 
chanical cause, and not upon feculent accumulation arising 
from functional derangement of the bowel, the faeces are 
always found soft — a provision of nature which tends to 
prolong life by enabling the bowels to relieve themselves 
until the passage becomes absolutely closed. 

Causes. — One of the most frequent causes of obstruction 
is an accumulation of impacted fceces. This, though the re- 
sult of a preexisting functional derangement of the bowels, 
becomes itself, when so considerable as to close the passage, 
and to resist the peristaltic movement, the chief source of 
mischief; and the obstruction, therefore, may be strictly 
said to be mechanical. This is the form of the complaint 
which is least dangerous, and most easily relieved by proper 
measures. A case is mentioned by O'Beirne, in which the 
patient had been without an evacuation from the bowels for 
nearly six months, in consequence of a mass of solid excre- 
ment in the sigmoid flexure, and yet was relieved by a 
stimulant injection thrown high up into the rectum. Such 
accumulation may be supposed to exist when the symptoms 
of obstruction have been long preceded by those of habitual 
constipation, without any evidence, from the appearance of 
the stools, of the existence of stricture. The means of 
detecting it have been already detailed. 

Another not uncommon cause of obstruction is the forma- 
tion of solid concretions in the bowels. They originate in 
various sources. Insoluble substances taken largely and 
frequently as medicines sometimes concrete in the. bowels, 
held together by a cement of animal matter or calcareous 
salt, and frequently mixed with indigestible portions of 
substances used as food. 

Permanent stricture of the bowels is a third source of ob- 
struction. This appears sometimes to originate in a spas- 
modic stricture becoming permanent by inflammatory adhe- 
sion ; but in most instances it depends on a thickening of 
the parietes of the bowel, and a consequent diminution of its 
calibre. 

Intussusception or invagination of the bowel, is a frequent 



494 FUNCTIONAL DERANGEMENTS. 

and fatal cause of obstruction. This consists of the intro 
duction of one portion of the intestine, by inversion, into 
the portion immediately above or immediately below it, thus 
producing, in many instances, a complete closure of the 
cavity. The upper portion is generally received into that 
below it, but not invariably so, the inversion sometimes 
taking place from below upward. The extent of the invagi- 
nation varies from a few lines to a foot or more. It occurs 
not unfrequently in more than one part of the bowels in the 
same case, and probably arises from a spasmodic constriction 
of the entering portion of the intestine. There is reason 
to believe that it frequently takes place during colic, and 
other spasmodic intestinal affections, without producing 
serious effects, being relieved by the spontaneous movement 
of the bowels. The diagnosis of intussusceptio is at first 
always uncertain. It may be suspected when the symptoms 
of obstruction come on suddenly, without previous disorder, 
or as the consequence of an attack of colic, or the adminis- 
tration of a dose of active purgative medicine, and when at 
the same time a tumor, not previously existing, can be felt 
in any part of the colon. 

Organic tumors, formed exterior to the bowel, may some- 
times so diminish its calibre as to produce obstruction ; but 
this result is rare, the impediment being seldom so great as 
altogether to prevent the passage of faeces. 

Treatment. — The first object in any particular case of 
obstruction is, if possible, to ascertain the cause, so that the 
treatment may be modified accordingly. But when this is 
very obscure, or altogether uncertain, as very often happens, 
that plan should be adopted which is most likely to be useful 
in curable forms of the complaint. As * a general rule, the 
following course of treatment is recommended. 

If the pulse and constitution admit, and especially if 
symptoms of inflammation exist, blood should be taken 
freely from the arm, and leeches applied to the abdomen or 
the anus ; a full dose of opium should then be given, and 
warm water poured perseveringly upon the bowels. (See 
Peritonitis.) Spasm of the bowel, which, if not the cause 
of the difficulty, may greatly aggravate it, may thus be 



OBSTRUCTION OF THE BOWELS. 495 

relaxed, while the dangers from inflammation are obviated. 
Purgatives may at the same time be resorted: to, as recom- 
mended for occasional constipation; and these should be 
aided by suitable enemata. For the composition of the 
enemata, the reader is referred to the article upon simple 
spasmodic colic. But, in relation to the use of purgatives, 
some caution is requisite. When the vomiting is very 
obstinate, and especially when it has become stercoraceous, 
there is strong evidence that the peristaltic movement of the 
bowels is exerted to its utmost limits ; and the only effect 
of powerful and drastic cathartics would probably be to 
increase the existing irritation or inflammation, and still 
farther to aggravate the vomiting. The reparatory processes 
which nature might be disposed to institute may thus possibly 
be interfered with, and a curable case rendered incurable. 
At the beginning of the treatment, active purges may be 
employed; but, when found unsuccessful, they should not 
be urged under the circumstances mentioned. Effervescing 
aperient medicines, or the saline cathartics given in small 
doses, should be preferred, as more acceptable to the stomach, 
and calculated to direct downward the already excited peris- 
taltic action. 

The repeated injection of large quantities of warm water 
into the bowels by means of a forcing-pump, as recommended 
in obstinate cases of constipation, is one of the most efficient 
remedies. If the obstruction consist in fecal masses or other 
concretions, it may thus be loosened, broken down, and 
gradually brought away ; if in intussusceptio or twisting of 
the bowel, there may be some hope, in the one case, of 
pushing up the invaginated intestine by the force of the 
stream., provided adhesions have not been formed, and in the 
other of untwisting the rotation by an impulse opposite to 
that which produced it. To insure its full effect, however, 
the fluid should be introduced by means of a tube passed as 
high as possible into the bowel. Even the ordinary purga- 
tive and stimulant injections prove much more efficient when 
introduced in this way. 

Efforts for the relief of the patient should never be aban- 
doned so long as life continues. If one measure fail, another 
32 



496 FUNCTIONAL DERANGEMENTS. 

should be tried, and nothing which affords any reasonable 
prospect of advantage should be neglected ; for success has 
often rewarded the efforts of the practitioner in these cases 
when there scarcely seemed to be ground for hope. When 
the strength of the patient begins to fail, it should be sup- 
ported by stimulants and nutritious food. Wine-whey, car- 
bonate of ammonia, egg beat up with wine, milk-punch, 
animal broths, etc., may be employed. Lime-water and milk 
in small and frequently repeated doses will sometimes lie 
upon the stomach when other nutriment is rejected. Opiates 
should be administered throughout the case, if required to 
give ease or produce sleep. In low states of the system, it 
may be proper to employ the purgative tinctures, as those 
of rhubarb, aloes, senna, and jalap, etc., preferably to other 
forms of cathartic medicine. In those cases which run on 
for months, it will be necessary to watch their progress 
carefully, in order to meet any offered indication, and favor 
the recuperative efforts of nature. 

A few remarks may be made in reference to particular 
cases of obstruction. Should the complaint depend upon 
faeces or concretions lodged in the rectum, the aid of the 
finger or of instruments should be resorted to. The latter, 
if cautiously used, may be even applied to similar obstruc- 
tions at the lower extremity of the sigmoid flexure. If 
there be reason to suppose that magnesia has concreted in 
the bowels, acidulous liquids should be given with the 
purgative. When the obstruction depends on stricture of 
the rectum, resort should be had to the bougie, unless in 
cases of scirrhus or cancer, in which this instrument can do 
no good, and may prove injurious by tearing the easily- 
lacerated structure. In permanent impediments of this 
kind, the best plan is to administer frequently small doses 
of the saline cathartics, so as to keep the passages in a 
liquid state, and thus prevent irritation. The use of laxa- 
tive mineral waters has been found very beneficial, under 
such circumstances, in alleviating the pains and protracting 
the life of the patient. If there is strong reason to believe 
in the existence of intussusceptio, twisting of the bowel, 
or other form of internal strangulation, there may possibly, 



SPASM OF THE (ESOPHAGUS.- 497 

under peculiar circumstances, and in cases otherwise des- 
perate, be some propriety in opening the abdomen and 
removing the mechanical impediment ; at least, the question 
of an operation may be entertained. A successful case of 
the kind is referred to in Dr. Eberle's Practice of Medicine, 
(2d ed., vol. ii., p. 341,) quoted from Hufeland's Journal 
for February, 1826. 

SPASM OF THE (ESOPHAGUS. 

This is a morbid muscular contraction of the tube, pro- 
ducing more or less difficulty of swallowing. 

Symptoms.— The spasm generally comes on suddenly, 
often, for the first time, during a meal. Upon an attempt 
to swallow, the food is arrested, and is either rejected im- 
mediately and with force, or is retained for a time, and then 
rises by regurgitation. The former event is apt to occur 
when the stricture is near the upper extremity, the latter 
when it is near the lower. Occasionally, after the food has 
been a short time in contact with the stricture, this gives 
way and allows it to pass into the stomach. In some in- 
stances, solids can be swallowed better than liquids, and 
the reverse is sometimes the case ; but in general any sort 
of food is sufficient to excite the spasm, when the morbid 
susceptibility exists. Severe pain often attends the spas- 
modic action, and the irritation occasionally extends to the 
larynx or lungs, producing much embarrassment of respira- 
tion, with a feeling of impending suffocation. Even where 
no effort at deglutition is made, there is frequently present 
a sense of constriction, and, in some cases, a feeling as of a 
ball ascending the throat, or moving from one part to the 
other. This is the globus hystericus of older writers. 
Hiccough and vomiting sometimes accompany the affection. 
Its duration is exceedingly various. An attack may con- 
sist of a single paroxysm, lasting only a few hours, or the 
spasmodic action may continue with exacerbations and 
remissions, and occasional complete intermissions, for 
months or years. Like most other nervous affections, it 
sometimes assumes the regular intermittent form. 

From organic stricture, the only complaint with which it 



498 FUNCTIONAL DERANGEMENTS. 

can be confounded, it may in general be readily distin- 
guished hy the suddenness of the attack, by the occasional 
absence of all the symptoms, so that the patient can swal- 
low easily, and by the other evidences of nervous disorder 
with which it is frequently attended. 

Causes. — Irritation of the mucous coat, from whatever 
cause, may produce the spasm when a predisposition to it 
exists. It is sometimes excited by inflammation of the 
oesophagus. Among the causes may be mentioned acrid 
substances swallowed, cold drinks during perspiration, par- 
tial exposure to cold air, violent and depressing emotions, 
the operation of the imagination, and the influence of dis- 
ease existing elsewhere, as of dentition, organic affections 
of the larynx, stomach, and uterus, and inflammation of 
the upper part of the spinal marrow. The predisposition 
usually consists in an excitable state of the nervous sys- 
tem, such as exists in hysteria, hypochondriasis, and gene- 
rally in an anemic debilitated condition of body. 

Treatment. — The indications are first to relieve the local 
affection, and secondly to correct the predisposition. The 
first is answered by remedies suited to relax the spasm di- 
rectly, and to diminish the nervous excitability of the part, 
so as to prevent the disposition to its recurrence. If in- 
flammation exist, it should be removed by the means already 
indicated. If the affection be purely nervous, recourse 
may be had to narcotic cataplasms, as of tobacco, henbane, or 
hemlock, to acetate or sulphate of morphia upon a blistered 
surface, to rubefacients, pustulating substances, or a seton 
applied to the back of the neck, and to the internal use of 
anti-spasmodics and narcotics, such as assafoetida, valerian, 
camphor, opium, henbane, and hemlock. Much good is said 
to have resulted from very cold drinks, and even ice is 
swallowed by the patient. 

To meet the second indication, remedies must be em- 
ployed calculated to remove the disease of other organs 
with which the spasm may be associated, and to correct 
any existing morbid state of system. These remedies are 
detailed elsewhere. It is sufficient here to mention, that it 
is usually desirable to invigorate the general health by 



CHOLERA MORBUS. 499 

chalybeates or other tonics, exercise, fresh air, a nutritious 
diet, the avoidance of coffee, tea, and tobacco, as habitual 
luxuries, and attention to the bowels and the various se- 
cretions. 

In the regularly intermittent form of the complaint, sul- 
phate of quinine will prove effectual. 

CHOLERA MORBUS, OR VOMITING AND PURGING. 

Frequent and violent discharges of bilious matter, both 
upwards and downwards, with painful gripings, constitute 
the disease called cholera morbus. 

In warm climates it is met with at all seasons of the 
year, and its occurrences are very frequent ; but in temper- 
ate and cold climates, it is apt to be most prevalent in the 
autumn, when there is excessive heat, or there are sudden 
transitions from heat to cold ; and the violence of the dis- 
ease has usually been observed to be greater in proportion 
to the intenseness of heat. These circumstances naturally 
induce us to presume that cholera morbus is the effect of a 
warm atmosphere producing some change in the state of 
the bile ; which change may consist either in the matter of 
the bile being rendered more acrid, or its being secreted in 
a preternatural quantity. In some instances the disease 
has been observed to proceed from obstructed perspiration, 
and likewise from food which has passed readily into the 
acetous fermentation, from unripe fruit, and acrid ingesta ; 
but these causes probably would not give rise to it without 
the predisposition acquired by preceding great heat, suc- 
ceeded by sudden transitions to cold, particularly in the 
evenings. 

That the functions of the liver are greatly deranged in 
cholera morbus is very certain ; but that the symptoms are 
caused wholly by the action of bile upon the mucous sur- 
faces, is now, I believe, acknowledged to be an erroneous 
opinion. When it is considered that there is a cold stage 
antecedent to that of action and excitement, and that the 
vomiting and purging occasionally exist for some hours be- 
fore the bile appears in the matter ejected, it must be evi- 
dent that there is a highly excited state of the mucous 



500 FUNCTIONAL DERANGEMENTS. 

surfaces, wholly independent of the biliary secretion. The 
causes of cholera morbus, as well as the symptoms and the 
appearances after death, evince clearly that the disordered 
action affects both the intestinal mucous surfaces and the 
liver. 

The disease usually comes on with nausea, soreness, pain, 
distention, and flatulency in the stomach, and acute griping 
pains in the bowels, succeeded after a time by a severe and 
frequent vomiting and purging of bilious matter, heat, 
thirst, a hurried respiration, and a frequent but weak and 
fluttering pulse. 

When the disease is not violent, these symptoms, after con- 
tinuing for a day or two, cease gradually, leaving the 
patient in a debilitated and exhausted state ; but where the 
disease proceeds with much violence, there arises great de- 
pression of strength, with cold clammy sweats, considerable 
anxiety, a hurried and short respiration, cramps in the legs, 
coldness of the extremities, and hiccough, with a sinking 
and irregularity of the pulse, which quickly terminate in 
death ; an event that not unfrequently happens within the 
space of twenty-four hours. 

Our opinion must ever be unfavorable, when the evacua- 
tions upwards and downwards are accompanied by great 
prostration of strength, much distention of the abdomen, 
intermitting pulse, cold clammy sweats, a short hurried 
respiration, constant hiccough, spasms of the extremities, or 
convulsions ; but a gradual diminution of the symptoms, 
especially vomiting, succeeded by sleep, or a gentle mois- 
ture on the skin, may be regarded in a favorable light. 

From the very irritable state of the stomach on the first 
attack of the disease, it is almost impossible for any kind 
of medicine to be retained on it, and every thing is thrown 
up again almost as soon as swallowed. To abate this irri- 
tation and evacuate the redundant or acrid bile, it will be 
necessary, during this stage of the disorder, to make the 
patient drink plentifully of diluent drinks ; tepid water 
alone, or flavored with peppermint, is as good as any. 

In addition to these means, flannel cloths wrung out of 
hot water, and sprinkled with chloroform liniment, should 



CHOLERA MORBUS. 501 

be applied to the stomach, taking care to renew them often. 
Warmth should likewise be applied to the extremities by 
means of bottles filled with hot water. 

As soon as the stomach is sufficiently cleansed by the 
diluents, we should endeavor to allay or put a stop to the 
irritation, by administering opium in sufficiently large doses, 
but, at the same time, in as small a bulk as possible. It 
may be given in the quantity of a grain or a grain and a 
half with four or five grains of calomel, in the form of a 
pill, and be repeated every two hours, as long as the ur- 
gency of the case may require ; if the pill is rejected, half 
a grain of morphine may be given in a little mint water, 
and this may be repeated as frequently as the former. In 
some instances, where the spasms have been so violent as 
quickly to - induce an alarming state of debility, I have 
known the vomiting stopped, and permanent relief obtained, 
by draughts of very hot water. 

After the administration of opium in the manner advised, 
it will be proper to immerse the patient as soon as possible 
in a warm bath, as this will be a likely means of checking 
the inordinate secretion of bile by restoring the circulation 
to the surface of the body, and of course relieving the or- 
gasm of the chylopoetic viscera. 

Opium, when given by the mouth, even in the smallest 
possible bulk, is frequently rejected by vomiting in cholera 
morbus ; but, if given in an enema, will often in a very 
short space of time completely remove all the urgent symp- 
toms, and transfer the patient from a state of torture to one 
of ease. Clysters of this nature, containing about a 
drachm of tinctura opii in each, ought therefore to be in- 
jected from time to time as long as the irritation at the 
stomach continues. 

A cataplasm of opium and camphor applied to the region 
of the stomach, will sometimes revert its retrograde mo- 
tions. In several cases where there prevailed great pain 
and irritation at the stomach, and where the patient could 
retain nothing on it, I have experienced the best effects 
from the external application of opium to the epigastric 
region, in the form of an embrocation. If the case proves 



502 FUNCTIONAL DERANGEMENTS. 

obstinate, paper may be saturated with chloroform liniment 
and applied over the stomach, and let remain until it 
blisters. 

As soon as a sedative effect is produced on the stomach 
and intestines, and the violence of the attack has somewhat 
subsided, a mild laxative will assist the calomel in carrying 
off any diseased secretions. 

Although we may have been so fortunate as to procure a 
remission of the symptoms, still, as the spasms have a great 
tendency in this disease to recur after the operation of the 
opium is over, it will be by all means advisable to continue 
its use for several days in such a manner as to keep up a 
constant effect. 

In ordinary cases, where the evacuations are moderate, 
astringents would be improper, as they might aggravate the 
complaint by retaining the vitiated bile in the intestines, 
which ought to be discharged as long as the morbid secre- 
tion from the liver continues. 

On recovery, the patient should pay particular attention 
to his diet, carefully abstaining from all things which might 
promote a return of the disease, and using only such as are 
light and nutritive, and which do not readily become 
acescent. He is likewise to pay a minute attention at the 
same time to the functions of the skin by flannel or other 
warm clothing, while the night air and sudden alterations 
of temperature are to be cautiously guarded against. 

There are some people who are subject to periodical 
attacks of cholera, returning by intervals of a few weeks, 
producing for two or three days sickness and vomiting, 
increased heat of the skin and quickness of the pulse, white 
tongue, and thirst. Sometimes, however, the bowels are 
torpid. Heaviness of the eyes and great disposition to 
drowsiness are commonly the precursors to the attack ; and 
if a dose of blue mass pills, joined with some gentle 
purgative, be then given, it will either considerably lessen 
its violence, or altogether prevent it. 

Exercise, particularly on horseback, tonics, and the saline 
or sulphur waters, are well calculated to afford relief and 
prevent recurrences of the complaint in all such cases. 



EPIDEMIC CHOLERA. 503 

EPIDEMIC CHOLERA SPASMODIC CHOLERA ASIATIC 'CHOLERA 

MALIGNANT CHOLERA CHOLERA ASPHYXIA. 

We will take the liberty of copying very extensively 
from Wood upon this subject. His description is plain and 
accurate, and his treatment simple and reasonable ; it will 
not do harm, which cannot be said of the heroic measures 
recommended by some authors and pursued by many prac- 
titioners. With regard to the march of cholera, Wood 
says : • 

No barriers were sufficient to obstruct its progress. It 
crossed mountains, deserts, and oceans. Opposing winds 
did not check it. All classes of persons, male and female, 
young and old, the robust and the feeble, were exposed to 
its assault ; and even those whom it had once visited were 
not always subsequently exempt ; yet, as a general rule, it 
selected its victims preferably from among those already 
pressed down by the various miseries of life, and left the 
rich and prosperous to their sunshine and their fears. It 
was exceedingly capricious in the choice of its localities, not 
unfrequently leaving towns and districts in its line of march 
untouched, and deviating apparently from its course to seize 
upon others, in no important respect differently circum- 
stanced. The period of its duration in any one spot was 
generally from one to two or three months, though this was 
much influenced by the season, being shorter for the most 
part when winter was near. When it prevailed in the same 
place more than once, it usually affected fewer persons, and 
was of a milder character in the second attack than in the 
first. 

Course, Symptoms, etc. — The first approach of the epidemic 
influence in places about to become the seat of cholera was 
usually felt in the more or less general prevalence of mode- 
rate disorders of the stomach and bowels, which preceded 
for a short time the appearance of the disease, and continued 
in various degrees to affect a large portion of the population 
after it had become established. Sometimes there was only 
a slight derangement of digestion, or a simple diarrhoea, or 
mild dysentery • but very frequently the premonitory affec- 



504 FUNCTIONAL DERANGEMENTS. 

tion took on a more decided character, and, without amount- 
ing absolutely to cholera, approached it more or less nearly, 
and from this circumstance received the name of cholerine, 
adopted from the French writers. 

Cholerine, in fact, often constituted the first stage of cholera, 
and in other cases was undoubtedly produced by the same 
cause, operating either more mildly or upon less susceptible 
subjects. It was marked by a furred tongue, irregular appe- 
tite, thirst, impaired digestion, uneasiness in the stomach 
and bowels, with a feeling of weight or distention, colicky 
pains, hiccough, diarrhoea sometimes disappearing and again 
recurring, nausea, sometimes vomiting, a feeling of general 
weakness and languor, a disposition to perspire, occasional 
neuralgic pains, and cramps in the extremities. In some 
instances, it was attended with febrile symptoms. The alvine 
discharges were sometimes bilious, sometimes of a dirty- 
white color and turbid, very much resembling oatmeal gruel. 
Occasionally the force of the cause seemed to expend itself 
upon the nervous system, and the patient was affected with 
severe neuralgic pains and distressing spasms, amounting 
sometimes to convulsions, with little or no evacuation from 
the stomach or bowels. The affection often subsided spon- 
taneously, or yielded readily to proper treatment ; but was 
very apt, upon exposure to any exciting cause, and even 
if neglected, without such cause, to be aggravated into 
cholera. 

When the epidemic influence had attained an intensity 
adequate to the production of the full-formed disease, a few 
cases were first observed, usually among the lowest orders 
of the community. These were soon followed by others ; 
and the numbers gradually increased until the pestilence 
reached its acme, when it speedily subsided, and ultimately 
disappeared, leaving behind it for a short time that same 
tendency to bowel complaints which had heralded its ap- 
proach. 

The attack often occurred after some imprudence in diet 
or exposure, but often, also, without any obvious exciting 
cause, and, according to some writers, most frequently in the 
night. It occasionally came on with loss of appetite, pain 



EPIDEMIC CHOLERA. 505 

in the back and abdomen, vertigo, noise in the ears, disor- 
dered vision, feebleness of the pulse, paleness of the face, 
copious sweats, a feeling of general weakness, and sometimes 
rigors. In the midst of these or similar symptoms, in most 
cases after a longer or shorter duration of diarrhoea or 
cholerine, but sometimes without any premonition whatever, 
the patient was seized with vomiting and purging, which 
were frequently repeated, and attended with severe pain in 
the abdomen, neuralgic pains in different parts of the body, 
and cramps of the ' voluntary muscles, especially those of the 
lower extremities. The first evacuations, in cases not 
originating in diarrhoea or cholerine, consisted of the ordi- 
nary contents of the stomach and bowels ; but the dejections 
which followed were of a whitish color, thin, and watery, 
resembling rennet-whey, thin gruel, or rice water, and, when 
allowed to stand, separated into a colorless fluid, and a 
white, flocculent, insoluble matter, which subsided. In mild 
cases, or after the subsidence of the severer symptoms, they 
were sometimes tinged with bile, and a little blood was 
occasionally discharged. In some instances, they are de- 
scribed as having been brown, or of a deep chocolate color. 
The matter vomited was generally similar to the stools, but 
was sometimes white and glairy, as if consisting of mucus, 
and had an acid reaction. The evacuations were usually 
forcibly ejected, but without apparent straining, or much 
voluntary effort, and were often very copious. 

The cramps usually began in the extremities, affecting 
especially the calves of the legs, but subsequently extended 
to the muscles of the trunk and abdomen. They were 
excruciatingly painful, and almost incessant, the muscles 
gathering into hard board-like knots, one contracting as 
another relaxed, and often distorting the fingers and toes in 
various directions, according to the particular muscle or 
muscles affected. 

At the same time, the pulse sank rapidly ; the extremi- 
ties became cold ; the features shrank ; the patient was 
restless, and complained of intense thirst; the whole sur- 
face was bathed with sweat ; the urine was scanty, and the 
skin began to assume a bluish, leaden, or violet color, which 



506 FUNCTIONAL DERANGEMENTS. 

extended more or less over the body, but was peculiarly 
striking in the face, hands, and feet. If the complaint was 
not arrested, the evacuations became still more copious and 
watery; the thirst insatiable, with a burning heat at the 
epigastrium; the pulse frequent, feeble, and sometimes 
scarcely perceptible ; the breath cool ; the tongue cool and 
pale, though still moist ; the skin unusually cold, shrunken, 
and inelastic, so that when pinched into folds it could not 
resume its former state ; the hands and feet shrivelled and 
wrinkled, as if long soaked in water, and of a dark, purplish 
or livid color, especially at the nails, which were sometimes 
almost black ; the eyes deeply sunk in their sockets, and 
surrounded with a livid circle ; the conjunctiva dry, and of 
a dirty whiteness ; the nose and lips blue ; the secretion of 
urine and tears suppressed; the respiration short, hurried, 
and oppressed, and every symptom indicative of 'extreme 
prostration. The patient was often exceedingly restless, 
and called incessantly for cold water or ice, and for fresh 
air. With all these changes, the external sensibility often 
remained acute, so that mustard plasters and other irritants 
produced severe pain; and, though cold to the touch, the 
patient frequently complained of a distressing heat over the 
whole surface. The intellect was generally sound, but more 
or less obtuse ; and in all his moral relations the patient 
evinced an extraordinary apathy, being insensible alike to 
his own danger and future prospects and to the feelings of 
those connected with him. 

The case was now on the borders of complete collapse. 
But a step farther, and the pulse became quite impercepti- 
ble ; a feeble oscillatory movement only of the heart was 
discoverable upon auscultation ; the blood stagnated in the 
capillaries ; a wound of the surface yielded no blood, and 
little or none followed the opening of a vein ; the features 
and whole body were so shrunken that the patient could 
scarcely be recognized by his friends ; the bluish or purplish 
color often pervaded the whole surface ; the voice was feeble, 
or quite extinct; the breath almost as cold as the external 
air ; the respiration either hurried and feeble, or very slow 
and scarcely perceptible; the countenance calm, or quite 



EPIDEMIC CHOLERA. 507 

inexpressive, and the whole aspect of the patient that of 
utter helplessness. The reduction of temperature was such 
that the thermometer, with its bulb placed under the tongue, 
sank often to 90°, and sometimes as low as 80°, or even 
77° F. The body had the appearance of death, except the 
eyes, which sometimes retained an expression of intelligence, 
and seemed as if they were looking out of a corpse. But 
even these were often half closed, glazed, and inanimate. 
In some instances, considerable muscular strength remained, 
and the patient suddenly rose up from bed with an expiring 
effort, and fell lifeless. The evacuations sometimes contin- 
ued till the close, and were at last involuntary. Sometimes, 
however, they ceased entirely for a considerable time before 
death. The same difference was observable in relation to 
the cramps, which, in some cases, did not end even with 
life, the muscles remaining stiff and contracted in the dead 
body. Intelligence was sometimes retained till within a 
few moments of the close. In other cases, a period of 
stupor preceded death. The fatal issue sometimes occurred 
in four or five hours from the commencement of the attack, 
though more frequently life was protracted for one, two, or 
three days. 

The complaint was susceptible of a favorable change, 
either spontaneously or by the aid of treatment, at any 
stage of its progress, even in that of collapse. If it was 
arrested early, the patient sometimes entered into a speedy 
convalescence, without any subsequent embarrassing symp- 
toms, though not unfrequently diarrhoea and other evidences 
of gastro-intestinal irritation continued for a longer or 
shorter period. But if collapse had begun before the turn 
of the disorder, the patient had still great dangers to 
encounter, and the progress of recovery, when it took place, 
was often very tedious, and liable to frequent interruptions. 
One of the most favorable symptoms in any stage of 
cholera was the appearance of bile in the evacuations. In 
the cases of collapse, after the system had begun to react, 
a gradual restoration of the suspended functions was 
observed ; the pulse returned, the skin became warm, the 
pallor or blueness of face yielded to a red flush, the secre- 



508 FUNCTIONAL DERANGEMENTS. 

tion of urine and bile recommenced, the vomiting dimin* 
ished ; but the oscillation extended frequently into a febrile 
excitement ; severe headache was experienced ; the abdo- 
minal pains, thirst, loathing of food, and diarrhoea continued ; 
and convalescence, even in favorable cases, did not set fairly 
in until after several days of doubt and discomfort. 

Sometimes a relapse followed the temporary excitement, 
and the patient sank with all his former symptoms. Much 
more frequently, however, the febrile state continued, gene- 
rally assuming a low form, with most of the characters of 
idiopathic nervous or typhoid fever, and unequivocal 
evidences of gastric or intestinal inflammation, and either 
ending in death or in a very slow recovery. In some cases 
the fever assumed the remittent type, and ultimately became 
intermittent. Various eruptive affections, resembling those 
of scarlatina, rubeola, erysipelas, etc., occasionally diversified 
the stage of reaction. Pneumonia, bronchitis, and pleurisy 
also not unfrequently occurred, but so masked by the low 
state of the system, and the continued gastro-intestinal 
irritation, as often to escape the notice of the practitioner, 
unless carefully upon his guard. But the most dangerous 
affection in this stage of cholera was perhaps that of the 
brain, characterized by severe headache, drowsiness, low 
delirium, stupor, coma, subsultus tendinum, and sometimes 
by convulsions or paralysis. In its severe forms it was 
almost always fatal. The convalescence from these various 
secondary disorders was often protracted for months, and 
sometimes even for a year or more. 

The course of the symptoms in cholera was not always 
uniform, nor exactly as above described. Sometimes the 
spasms were comparatively trifling or altogether absent, 
sometimes they constituted the chief feature of the case, to 
the exclusion of the ordinary evacuations. In some 
instances the complaint was ushered in by universal and 
violent convulsions. Cases were frequently observed in 
which fatal collapse supervened without vomiting, and 
others are on record in which there was neither vomiting 
nor diarrhoea; though, in such instances, the bowels, upon 
examination after death, were found loaded with the same 



EPIDEMIC CHOLERA. 509 

whitish liquid of which the discharges consisted. In some 
rare instances, vomiting occurred with little or no diarrhoea. 
Though in general there was an interval of some hours, and 
sometimes of a day or more, between the attack and the 
occurrence of the collapse, so as to allow time for the inter- 
vention of efficacious treatment, yet instances were not 
unfrequent in which the patient passed almost immediately 
into that state, and died apparently under the first blow. 
The bluish aspect of the surface, so characteristic of 
cholera, was not present in all cases, not even in all those 
which terminated fatally. Instead of the sinking pulse, so 
common even in the onset of the disease, the circulation 
was sometimes little affected for a considerable time ; and 
in some cases, febrile symptoms, with a strong and excited 
pulse, showed themselves in the first stage. The intellect, 
usually correct, though obtuse, was in some cases clouded 
almost from the commencement ; and instances occurred in 
which determination of blood to the head, with drowsiness, 
stupor, and numbness of the extremities, were the prominent 
symptoms. 

From an examination of the symptoms above detailed, it 
will be perceived that a fully developed case of cholera, 
running through a regular course, often exhibited four 
distinct stages, the observance of which was important in a 
practical point of view. The first was the forming stage, 
consisting of a simple diarrhoea, or of more or less of those 
derangements described under the head of cholerine. The 
second was that in which the symptoms of cholera were 
decided, but the system had not yet sunk into complete 
prostration, and the circulation was distinctly observable, 
both in the larger vessels and capillaries. The third was 
the stage of collapse, already sufficiently described. The 
fourth was that of reaction, in which the characteristic 
symptoms of cholera had given way to local inflammations 
or irritations, and to general fever. All these stages did 
not by any means occur in all cases. The disease was often 
arrested in the first or second, or proved fatal in the third, 
without ever reaching the fourth ; and sometimes the second 



510 FUNCTIONAL DERANGEMENTS. 

or even third stage came on without the known existence 
of those ordinarily preceding it. 

The predisposing causes were very numerous. Whatever 
was calculated to diminish the vital energies, or to reduce 
the vital actions below the standard of health, may be 
ranked among these causes. Not only were debilitated 
individuals in greater danger when laboring under the 
disease ; they were also much more liable to its attack. 
Previous disease, old age, intemperance, vicious indul- 
gences of all kinds calculated to impair the health, deficient 
alimentation, an exclusive vegetable diet, confined air, 
especially in low and damp places, the effluvia of crowded 
residences, continued grief, fear, anxiety, and other depress- 
ing emotions, all these predisposed to cholera. 

Nor were the exciting causes less numerous. Indeed, the 
two sets of causes often acted interchangeably; those 
which in some cases excited the disease producing a pre- 
disposition to it in others, and vice versa. Whatever could 
make a sudden and powerful impression on the system, and 
whatever could irritate the stomach, was capable of convert- 
ing a tendency to cholera into its reality. One of the most 
common exciting causes was a sudden exposure to cold 
when the body was warm and perspiring. Hence, in part, 
the injurious effects of the night air and of damp places. 
Sudden and strong emotions often brought on an attack. 
Indigestible food, such as unripe fruit and crude vegetables; 
excessive eating, even of wholesome food ; unwholesome 
drinks, including impure water, cider, poor wines, and 
imperfectly fermented liquors of all kinds ; very cold drinks 
and ices taken too freely, especially when the body was 
heated ; purgative medicines, particularly those of a drastic 
character ; these, and many other causes operating in a 
similar manner, were capable of exciting the disease in 
persons previously exposed to the specific influence. 

From a combination of these causes it is that the ravages 
of cholera have been experienced especially by the poorest 
and most wretched of the population in every country ; by 
the intemperate, the debauched, the ill-fed and ill-clothed, 



EPIDEMIC CHOLERA. 511 

the badly-lodged, the over-worked, the tenants of prisons 
and alms-houses, the inhabitants of crowded and filthy 
suburbs, or of miasmatic districts, soldiers fatigued by long 
marches, sailors shut up in the holds of ships, and garrisons 
crowded in damp and badly provided camps or fortresses. 
In India the natives, who live chiefly on vegetable food, 
suffered much more than the Europeans. In Havana, the 
proportion of deaths to the population was, among the 
colored people in general, more than twice as great ; and 
among the free African negroes, who are probably the worst 
provided, about four times as great as among the whites. 
In cities, it was almost always the lowest, dampest, most 
crowded, and most filthy sections that suffered first and 
most. In general, the well-provided classes of society 
suffered little in any country, though there were almost 
everywhere occasional exceptions to this rule. The ravages 
in different countries or sections of the globe bore, in 
general, an inverse proportion to their well-being. Thus, 
Asia suffered more than Europe, and Europe more than 
North America. 

The time requisite for the production of cholera, after 
exposure to the epidemic cause, is indefinite, but often very 
short. Instances are on record, in which persons, arriving 
in perfect health in an affected neighborhood, have been 
attacked within two or three da} r s, and even within a single 
day from the time of their arrival. 

By many the epidemic cholera is believed to differ from 
ordinary cholera only in its violence. There is undoubtedly 
considerable resemblance between the two affections ; but I 
nevertheless believe them to be distinct. In cholera mor- 
bus the evacuations are generally bilious, in epidemic 
cholera they are rarely so. This difference has been 
ascribed to the greater severity of the latter complaint; 
and it is stated, in support of this view, that bile often ap- 
pears in the discharges of epidemic cholera, when it begins 
to moderate. But the distinctive sero-albuminous character 
of the dejections in this affection is observed even in very 
mild cases, which vield readily to treatment, and which are 
33 



512 FUNCTIONAL DEEANGEMENTS. 

certainly less violent than the higher grades of cholera mor- 
bus. Were the two affections identical, there ought to be 
a point, in their respective gradations of severity, in which 
they should exactly coincide. Though I have seen much 
of cholera morbus, both in public and private practice, I 
have not met with a case exhibiting exactly the rice-water 
evacuations of the epidemic disease. There is often great 
and sometimes fatal prostration in the former affection ; but 
the blue skin, the shrivelled extremities, the universal 
shrinking away of the flesh, and the peculiar mental apathy, 
are generally if not always wanting ; and the neuralgic and 
spasmodic symptoms, if present, are so in a much less de- 
gree. Ths differences in the seasons at which they occur, 
the persons they attack, the situations they respectively 
affect, their cause, course, and termination, are other rea- 
sons for considering them as essentially distinct affections. 

Prognosis. — Treated in the forming stage, while yet in 
the state of diarrhoea or cholerine, the disease could almost 
always be arrested. Even when completely formed, if not 
advanced to the stage of collapse, it terminated favorably, 
under appropriate management, in the vast majority of 
cases. But in the collapsed state, with the fluttering or 
absent pulse, the cold and leaden surface, the suspended 
capillary circulation, the sunken and inexpressive features, 
and complete mental apathy, the patient was already in the 
grasp of death, and medicine could be of little avail. Very 
few rose out of this condition, when completely formed ; 
and the danger was in proportion to the degree in which it 
was approached. From the rapidity of the disease, and 
the destitute state of many of those most exposed to it, 
the patient was very often reduced to this condition of col- 
lapse before medical aid could be obtained. Hence the 
great mortality of this fearful epidemic. The published re- 
ports of cholera generally have reference to the disease as 
witnessed in hospitals, or other public institutions, where 
the worst cases were crowded together, and often in the 
last stage. The inmates of these institutions were, more- 
over, very frequently of the classes least able to resist the 



EPIDEMIC CHOLERA. 513 

disease; such, namely, as were already debilitated by age, 
disease, want, excessive fatigue, or intemperance. Among 
these, cholera has always made terrible havoc. 

In forming an estimate of the probable result, in any 
particular case, all these circumstances were to be consid- 
ered. In the early stages, before the symptoms of collapse 
had come on, in a young or middle-aged, previously healthy, 
and robust individual, and especially if the case occurred in 
the decline or towards the close of the epidemic, a favora- 
ble termination might be reasonably expected. If, during 
the collapse, the pulse began to rise, the skin to become 
warm, and the secretions of bile and urine to return, there 
w r as hope for the patient ; though, in giving an opinion, it 
was necessary to bear in mind the great dangers of the 
stage of reaction. When the attack was violent, and has- 
tening into collapse, or this condition had already occurred, 
and when the seizure took place at the commencement of 
the epidemic, in an individual more than fifty years old, or 
previously much debilitated from any cause whatever, the 
most serious consequences were to be apprehended. Dry- 
ness of the cornea, ecchymosis of the conjunctiva, and a 
perfect stasis of the blood in the capillaries, as indicated by 
the want of any change of color in the gums or inner sur- 
face of the lips upon pressure with the finger, were certain 
signs of approaching death. 

Treatment. — The plans of treatment which have been 
employed in epidemic cholera are almost as numerous as 
the combinations of which remedies are susceptible; and, 
judging from the reports upon a great scale, there seems to 
have been little difference in the results ; for the propor- 
tion of deaths has generally varied from one-half to one- 
third, no matter what was the locality, or what the means 
of cure resorted to. This apparent uniformity has no 
doubt arisen in part from the circumstances, that, of the 
cases reported, a very large proportion was utterly beyond 
the reach of remedies, and that, in any particular place, the 
favorable and unfavorable results of the different modes 
of treatment pretty nearly counterbalanced each other. 
When, however, a discriminating view is taken of the whole 



514 FUNCTIONAL DERANGEMENTS. 

ground, and the published results of individual practitioners 01 
individual institutions, in connection with the treatment em- 
ployed, are compared, we still find insuperable difficulties in 
coming to a just conclusion as to the most effective plan; great 
success being often claimed for the most different and even 
opposite remedies, by their respective advocates. In de- 
ciding, therefore, for himself, the physician is necessarily 
thrown off of the ground of general experience, upon that 
of principle and his own individual observation. I shall 
first give a sketch of the plan of treatment suggested by a 
judgment formed upon this basis, and afterwards a detail 
of various other plans, recommended by their apparent 
merits, or the testimony in their favor. 

In the absence of any certain pathology of the disease, 
the efforts of the practitioner should be directed to 
the correction or removal of obvious disturbances of the 
functions, and thus to put the system as nearly as possible 
into its normal condition. The indications of treatment, in 
the first and second stages of the disease, deducible from 
the obvious phenomena, are, to arrest the evacuations from 
the stomach and bowels ; to relieve irritation of the gastro- 
intestinal mucous membrane ; to restore the suspended secre- 
tions, especially that of the liver ; to equalize the circula- 
tion ; to relieve the nervous disturbance ; and to support, 
when necessary, the general strength. Of these the most 
important is to arrest the alvine evacuations ; for it is by 
their continuance and increase that the fatal condition of 
collapse is generally induced. But the measures best cal- 
culated to answer this indication are such as will meet, to a 
certain extent, most of the others also ; as the evacuations, 
if not the result of the irritation, are probably promoted by 
the sanguineous congestion which it induces ; and the resto- 
ration of the suspended secretions, and the equalization of 
the circulation, must tend to diminish this congestion. 

Among the remedies best calculated to meet the above 
indications are opium and calomel, in small and frequently 
repeated doses, combined, when the discharges are copious, 
with acetate of lead, and, in addition, if this should prove 
insufficient, with kino, catechu, or the extract of rhatany. 



EPIDEMIC CHOLERA. 515 

Large doses of opium are considered, and probably are, inju- 
rious, by obtunding the nervous system below the point of 
necessary impressibility, and thus inducing torpor and even 
coma, and favoring congestions of the brain and other great 
internal organs. In small doses, on the contrary, it proves 
highly useful by checking exhalation into the bowels, de- 
termining to the surface, relieving pain and allaying irrita- 
tion, and sustaining a moderate, general, diffusive excite- 
ment. Minute and frequently repeated doses of calomel 
have the effect of stimulating the hepatic secretion, without 
irritating the stomach. It is indeed highly probable that 
they have a tendency directly to allay gastric irritation; 
and, if the general mercurial influence is induced, it may 
prove useful not only by changing the existing morbid ac- 
tion, but also by obviating in some degree the danger of 
inflammation in the fourth or last stage. The mercurial 
pill may often be advantageously substituted for calomel, in 
equivalent doses. Acetate of lead acts by the combination 
of astringency with a directly sedative influence upon the 
mucous membrane; kino, catechu, and extract of rhatany, 
by their astringency alone. The mutual reaction of these 
substances, though resulting in the formation of new com- 
pounds, does not by any means necessarily imply a thera- 
peutical incompatibility. In relation to the combination 
and exact dose of the above remedies, the practitioner must 
be guided by the degree of severity and the peculiar cir- 
cumstances of each particular case. In the mildest cases, 
opium and calomel may be employed alone ; in those of a 
higher grade, the acetate of lead should be added ; and in 
the most obstinate, all should be given simultaneously. 
The dose should be such as to admit of repetition every 
half hour or hour, during the height of the disease ; after 
which the interval may be gradually lengthened. From 
one-twelfth to one-half of a grain of opium, from one-sixth 
of a grain to one grain of calomel, from one-third of a 
grain to two grains of acetate of lead, and from Wo to five 
grains of kino or extract of rhatany, are suitable quanti- 
ties ; and they are best given in the pilular form. 

During the administration of the above remedies, the 



516 FUNCTIONAL DERANGEMENTS. 

patient may be allowed to swallow frequently very small 
quantities of cold carbonic acid water, which tends at the 
same time to relieve the burning thirst, and allay the vom- 
iting. If this cannot be had, small doses of the efferves- 
cing draught may be substituted. A little very cold water 
every now and then, or small pieces of ice, will be found 
\eij grateful to the patient. Whatever liquids are admin- 
istered should be cold, as heat increases the thirst, and 
already intolerable burning of the stomach. Lime-water 
and milk are sometimes useful in allaying the gastric irrita- 
tion ; and some of the aromatic waters may be employed 
for the same purpose. In cases requiring stimulation, the 
aromatic spirit of ammonia will often admirably answer 
both indications. At the same time, a sinapism of pure 
mustard should be applied over the epigastrium ; and, when 
opiates, given by the mouth are rejected, enemata of thirty 
drops of laudanum, with mucilage or thin starch, should be 
substituted. 

To equalize the circulation and nervous excitement, efforts 
should be made to bring about action upon the surface of 
the body. For this purpose, dry heat, and moist heat by 
means of the warm bath or vapor bath, have been recom- 
mended. These may sometimes be advantageous in the 
earlier stages ; but, at a more advanced period of the dis- 
ease, when they would seem to be yet more strongly indi- 
cated, experience has not pronounced in their favor. Though 
the surface may be cold, the patient has not unfrequently 
an opposite feeling, and suffers greatly from hot applications. 
These, moreover, are apt to increase the perspiration, al- 
ready, in many instances, exceedingly abundant, and thus 
to aid the alvine evacuations in the exhaustion of the serous 
portion of the blood, and consequently to hasten the col- 
lapse. Hot pediluvia, rendered stimulating with mustard, 
cayenne pepper, or common salt, may be used in all cases 
in which the extremities merely are cold. The best mode 
of effecting a centrifugal excitement is' by moderate frictions 
over the surface, either by the hand alone, or with flannel, 
coarse towels, or a flesh-brush, or in connection with rube- 
facients. Care must be taken to avoid injury to the skin 



EPIDEMIC CHOLERA. 517 

by the violence of the friction. This remedy often affords 
great relief to the cramps. Frictions over the whole sur- 
face of the body with mercurial ointment, mixed with half 
its weight of camphor and one-quarter of its weight of 
cayenne pepper, urged to salivation, were employed with 
the happiest results by Dr. Lee, of New York. ' (American 
Journal of Medical Sciences, x. 544.) 

Peculiar circumstances may require additional remedies. 
In those rare cases in which the pulse is full and strong, 
especially if connected with convulsive symptoms, blood 
should be taken from the arm. Leeching to the epigastrium 
is indicated in the earlier stages, when there is tenderness 
with burning pain in the stomach. Prostration must be 
obviated by the diffusible stimulants, especially in intem- 
perate persons, though little good can be expected from 
these remedies in the state of collapse. Tincture of cam- 
phor, aromatic spirit of ammonia, and the ethereal prepara- 
tions, are among the best. Sound port wine or brandy, 
diluted with cold water, and impregnated with mint or other 
aromatic, may also be used, though with caution. The 
camphorated tincture of opium is admirably adapted to mild 
cases of the disease, or to its earliest stage. 

The above remedies must of course be graduated to the 
severity of the case ; and, in the forming stage, while the 
disease is yet in the state of diarrhoea or cholerine, it may 
not be necessary to resort to any other remedy than an 
opiate, with or without calomel or the blue-mass, according 
as the hepatic secretion is or is not deficient. It is, how- 
ever, of the utmost importance to arrest the disease in this 
stage, and the simple means necessary for this purpose be- 
come highly valuable remedies. When the stools retain 
the natural color, a teaspoonful of the camphorated tincture 
of opium three or four times a day, or from five to ten 
drops of laudanum, with a few drops of tincture of camphor, 
repeated as often, will very frequently be sufficient, along 
with a proper regimen, to check the preliminary diarrhoea, 
and thus ward off an attack of the cholera. Should the 
stools be white, or very light-colored, the mercurial should 
be conjoined with the opiate in alterative closes, and the 



518 FUNCTIONAL DERANGEMENTS. 

addition of a small proportion of ipecacuanha to each dose, 
insufficient to nauseate, will be found advantageous. Should 
the stomach be loaded with undigested food during the 
forming stage, the treatment may very properly be com- 
menced with a gentle emetic of ipecacuanha. Should ccs- 
tiveness follow the use of the means requisite for checking 
the disease, it should be corrected by the mildest possible 
measures ; and rhubarb is perhaps the best laxative for the 
purpose. 

In the stage of collapse, the same indications are presented 
as in the previous stages, with two additional ; namely, to 
check the excessive sweats, and to supply the loss of watery 
fluid and salts which has been sustained by the blood. 
There would seem to be even a stronger call for active 
stimulation; but experience has shown that this measure 
should be employed with some reserve. In the existing 
state of the circulating fluid it can be of little avail, and, 
when carried too far, it has the effect of still further aggra- 
vating the danger, by increasing the already excessive 
sweats, and exhausting the little remaining excitability of 
the system. The stimulants, however, already mentioned, 
may be used in small and frequently repeated doses, and 
continued, if found productive of no ill effects. The efforts 
to restrain the evacuations from the stomach and bowels, if 
these continue, should not be abandoned ; and, though ex- 
ternal heat has been found productive of little good, attempts 
should still be made to excite the surface by frictions and 
rubefacients. Sinapisms may be applied to the abdomen 
and extremities, and cayenne pepper and brandy, oil of 
turpentine, tincture of camphor, liniment of ammonia, etc., 
over the surface of the body. To close the cutaneous ex- 
halant orifices, astringent solutions may be employed, such 
as a saturated solution of alum in brandy; and, for the 
same purpose, as well as indirectly to excite the skin, fric- 
tions with ice or iced water have been strongly recommended, 
and are said to be often very grateful to the patient. To 
repair, as far as possible, the loss of water and salts by the 
blood, the patient should be allowed to drink frequently of 
carbonic acid water with bicarbonate of soda in solution, 



EPIDEMIC CHOLERA. 519 

weak animal broths, with salt, iced water, iced brandy and 
water, gum-water, barley-water, etc. ; and injections of salt 
water with laudanum may be occasionally thrown up the 
bowels'. 

When reaction has begun, the stimulants should be mode- 
rated or withdrawn, and attention confined chiefly to the 
correction of the quality of the blood, by the continued use 
of suitable drinks, and to the obviating of any local irrita- 
tions which may appear. 

When reaction is established, the treatment must be made 
to conform to the variable morbid conditions presented, and 
must be guided by the general principles applicable to other 
affections. One fact, however, must be borne in mind — that 
the inflammations which are apt to occur, cannot, in conse- 
quence of the previous exhaustion, be treated with the same 
activity of depletion as under ordinary circumstances. 
Blood must be cautiously abstracted, and cupping or leech- 
ing is in general preferable to the lancet. Reliance must be 
placed chiefly upon fomentations, blisters, the mercurial im- 
pression, and a properly regulated regimen. If a typhoid 
state of disease appear, it may be necessary to have recourse 
to tonics and stimulants, as sulphate of quinia, serpentaria, 
carbonate of ammonia, wine-whey, oil of turpentine, etc., as 
employed in the ordinary typhoid fever. 

Attention to the diet is very important. In the prelimi- 
nary diarrhoea, while the appetite continues in a greater or 
less degree, the food should be of the least irritating and 
most digestible kind. Stale bread, crackers, boiled rice, 
milk, cream, light broths, and boiled meats of easy digestion, 
(see Dyspepsia,) may be employed. When the disease is 
established, the diet should consist of mucilaginous and 
farinaceous liquids, or very weak chicken or mutton water. 
Milk, in very small quantities, with lime water, sometimes 
proves useful both as food and medicine. During conva- 
lescence, the utmost caution should be observed to avoid 
indigestible, flatulent, or irritating substances. The farina- 
ceous preparations, and the lighter kinds of animal food, 
should be preferred. The dietetic rules given in dyspepsia 
and chronic gastritis are applicable here. 



520 FUNCTIONAL DERANGEMENTS. 

Much may be done by proper prophylactic measures to 
avoid the disease, or render it milder. The diet should be 
of such a character as to preserve the digestive organs and 
the general system in the soundest possible state, so that 
they may be neither over-stimulated nor depressed. It 
should consist of a mixture of vegetable and animal food, 
avoiding indigestible, flatulent, acid, and irritating sub- 
stances, but admitting the more digestible fruits, when not 
forbidden by an already debilitated or irritated condition of 
stomach. They are useful by obviating costiveness, and 
the consequent necessity for the use of cathartic medicines. 
All those drinks should be shunned which have been men- 
tioned as exciting causes of the disease. Habits of tempe- 
rance both in eating and drinking are all-important ; but for 
an individual accustomed to the use of stimulating drinks 
or food, there might be some clanger in a sudden change. 
A moderate elevation of the vital functions is preferable to 
their depression ; and hence the use of gentle stimulants, 
such as ginger, mustard, black and cayenne pepper, in 
moderation, may prove serviceable. An equable state of 
mind should be preserved as far as possible ; and excessive 
fatigue, sensual indulgences, exposure to sudden changes of 
temperature, and especially to the damp night air, should 
be avoided. 

In relation to the various plans of treatment not included 
in the above statement, a very general sketch must suffice. 
Bleeding in all stages of the disease, even in that of col- 
lapse, has been the remedy chiefly depended upon by some 
practitioners. Others have placed great reliance upon 
emetics of ipecacuanha, mustard, or warm brine ; and even 
purgatives have found their advocates. In the East Indies, 
and subsequently in some parts of the United States, 
calomel in large doses, with or without opium, was a favorite 
remedy ; and the quantities administered with impunity in 
certain cases would seem scarcely credible, were they not 
well authenticated. Frequent draughts of hot water were 
highly lauded, as constituting the most effectual treatment, 
by one practitioner; while another spoke with equal confi- 
dence of the almost exclusive use of cold drinks and cold 



EPIDEMIC CHOLERA. 521 

water, or ice, applied externally. Some relied upon opium, 
brandy, and other stimulants ; the school of Broussais, on 
the contrary, upon cool and demulcent drinks, leeches to 
the epigastrium, and the external use of fomentations and 
rubefacients. Great success has been claimed for a treat- 
ment in which the prominent measure was the application 
of irritants over the spinal column ; ammonia, oil of turpen- 
tine, and a heated flat-iron, being employed for the purpose. 
The doctrine of Stevens, that the salts of the blood are 
essential agents of its arterialization, and the well-ascer- 
tained loss of these salts by the evacuations which take 
place in cholera, led to the use of the non-purgative salts, 
such as bicarbonate of soda, chloride of sodium, chlorate of 
potassa, etc., as the main remedial measure. From the 
same idea of restoring to the blood the constituents lost 
during the disease, originated the practice of injecting into 
the veins during the collapse large quantities of warm water, 
holding common salt and carbonate of soda in solution, in 
the proportion in which these salts are found in the serum 
of the blood. The happiest effects seemed for a time to 
result from this remedy ; the pulse returning, the surface 
assuming its natural color and fulness, and the patient 
reviving into the appearance of convalescence; but the 
evacuations returned, and collapse generally ensued, fol- 
lowed by speedy death. Nevertheless, the remedy is 
worthy of attention, as it affords some prospect of benefit 
in cases otherwise almost hopeless ; and instances have 
occurred in which, by the simultaneous use of internal 
remedies calculated to restrain evacuations, a return of 
collapse has been prevented, and the patient restored to 
health. Besides the above plans of management, particular 
articles of the Materia Medica acquired a more or less 
diffusive credit with the profession or the public. Among 
these may be mentioned tincture of camphor, charcoal, sul- 
phate of quinia in very large doses, and galvanism. But, 
as before observed, experience has not pronounced so favor- 
ably in Telation to any of these remedial means, as to 
obviate the necessity of a recourse to general principles : 
and the author has already given his views as to the course 



522 FUNCTIONAL DERANGEMENTS. 

of treatment which these principles appear to him to 
suggest. — Wood. 

We have nothing to add to the above admirable descrip- 
tion of this terrible disease, and but little that is entirely 
satisfactory with regard to its treatment. We have care- 
fully collected all reliable information upon this subject from 
all available sources, whether regular or irregular, and have 
had ample opportunity of studying it at the bedside, having 
met it in each of its visitations to this country ; seen it in 
all its grades, from the slightest indisposition to that 
appalling form in which Death appeared without precursors ; 
when a strong man, while in social converse after dinner 
with fellow-boarders, became at first sensible of vague un- 
easiness, then of a distressing sinking, and, sending promptly 
for medical aid, was found blue and pulseless, without 
having gone through the formalities of vomiting, purging, 
and cramps, and so gave up the ghost without apparent 
reason — without manifestation of the secondary agencies by 
which the King of Terrors usually removes his victims. It 
was thus, perhaps, that the "angel of the Lord" smote the 
hosts which Sennacherib led up to destroy God's chosen 
people, for, when the Israelites arose in the morning, " they 
found they were all dead men." But, besides seeing the 
disease, the author has twice had the opportunity of study- 
ing it in his own person, and after all can only say that it 
is "a visitation of the Lord," and pray that God would stay 
"the messenger of his wrath." 

Yet something can often be done, "something, too, for 
the benefit of the patient," and we will give the best that 
we have on hand by way of advice to the reader upon this 
fearful subject. When cholera visits your town or coun- 
try you should try to be absent, and if there get away 
with all your loved ones as soon as possible : it is not 
cowardice to flee : it is prudence to get out of the track of 
the tornado, or retreat before an overwhelming flood ; but 
if your duty to others makes it necessary for you to stay, 
be cheerful, and trust in God; avoid bustle, excitement, 
fatigue, improper indulgence, great change of habits, or any 
thing else which would have a tendency to interrupt the 



EPIDEMIC CHOLERA. 523 

equilibrium of quiet health, and disturb or weaken the 
vital powers by which alone the system can successfully 
resist morbid influences and keep off disease. Therefore, 
make no great change in your diet or mode of life, but eat, 
and sleep, and take such exercise as you have been in the 
habit of; and, if possible, be cheerful, and banish fear: 
fear alone is sufficient in many cases to produce all the 
common symptoms of cholera. A very striking case in 
proof of this came to the knowledge of the author a few 
years ago. A gentleman, and his wife and children, who 
had been on a visit to some relatives, were crossing the 
wire-bridge in their family carriage at the time that the 
recently-introduced cedar cross-pieces gave way under the 
pressure of a very heavily laden wagon, precipitating the 
wagon, team, and driver into the watery depths below, and 
from which only the driver was rescued, and this family 
only escaping by a few feet of solid flooring. The shock 
received by the lady was such; that in a few minutes an 
attack simulating cholera supervened, with all its charac- 
teristics of a sense of sinking, quickly followed by vomiting, 
purging, cramps, and great prostration; and yet this lady 
had been in good health, was not of an unusually nervous 
temperament, and at the moment of the catastrophe was 
enjoying maternal delight from listening to the prattle of 
her little ones. No cholera was then in the city, nor in the 
United States, but this factitious case was sufficient to cause 
a detention in the city of several days, before the lady 
could be removed to her home, some twenty miles distant. 

It is, therefore, of the highest importance when cholera, 
or any other fatal epidemic, is prevailing, to preserve a 
quiet and hopeful state of mind, and give no place to fear, 
for "there is luck for the brave." 

But if the disease comes, and you feel the premonitory 
symptoms, do not become excited, but lie down and take 
some gentle quieting medicine — a little brandy and lauda- 
num, or two or three teaspoonfuls of paregoric or Bate- 
man's drops ; don't take cholera medicines so called : they are 
nearly all too strongly stimulating, and tend to increase 
nervous disturbance. But if the symptoms increase, and 



524 



FUNCTIONAL DERANGEMENTS. 



there be a sense of oppression about the region of the 
stomach, with some vomiting or desire to vomit, take a 
mustard emetic — -half a teaspoonful of ground mustard in 
a glass of water — which, followed by copious draughts of 
tepid water, will soon effectually w^ash out the stomach, 
and clear it of any offending matter which happens to be 
present, and, at the same time, tend to promote an equilib- 
rium in the circulation. Now take one or two of the pills 
of opium and calomel recommended above; have mustard 
applied to the epigastrium, and to the wrists and ankles ; 
as soon as the mustard begins to burn unpleasantly, remove 
the plasters to a fresh surface, and thus, by shifting them, 
keep up a gentle stimulation without producing that degree 
of excitement which might lead to nervous disturbance. 

But if, notwithstanding the use of these means, the dis- 
ease progresses, and violent cramp, or distressing vomiting, 
or wasting discharges from the bowels come, still do not 
become alarmed, so as to ldse your prudence and swallow 
killing doses of calomel or opium, or any other drug ; yet 
a decided impression may now be attempted to be made by 
external means : chloroform liniment, with half the quantity 
of laudanum, may be applied to the spine and to the 
stomach and bowels by rubbing, or, which is a more efficient 
way, by saturating cloths or paper, and applying to the 
surface. 

This will rarely fail to arrest the disease for the present ; 
but after an hour or two, symptoms of restlessness com- 
monly begin to appear : the patient will change his position 
often, and moan as from pain ; and yet will reply that he is 
better, if interrogated. The abdomen, if now examined, 
will be found to be enlarged and hard, and hotter than 
natural ; the fluids are being concentrated in the internal 
vessels, and soon the capillary exhalants will pour out a 
deluge of hot rice-water discharges ; the patient will call 
urgently for water, which will be rejected, and cramps and 
general prostration leading to collapse will usually speedily 
follow. But if this stage be anticipated, it may almost 
always be prevented, or be removed if it has already come, 
by the use of very simple means. The surface is now cold 



EPIDEMIC CHOLERA. 525 

and the pulse faltering, and hence heat and stimulants are 
at once suggested to the mind as being called for ; but this 
is a mistake — one, too, which often leads to fatal results ; 
for you will find that, though the surface feels cold to an- 
other, it feels hot to the patient, and any artificial heat will 
greatly annoy and depress him ; then .there is absolute heat 
internally, as may be known by observing the temperature 
of the discharges, these being often so hot as to smoke 
when exposed to the air. What does this state of things 
indicate should be done ? Clearly, that an effort should be 
made to reduce the internal heat. But draughts of cold 
water will not do it, for they reach no farther than the 
stomach, being instantly rejected, and the heat is in the 
bowels ; the cold wet sheet to the abdomen may and some- 
times does succeed in soliciting the heat to the surface and 
absorbing it there, but this measure frequently fails, and 
only serves to determine the fluids still more to the inter- 
nal parts. Little reliance can now be placed upon revul- 
sion to the surface, as the sympathies between different 
parts of the system are feeble, or entirely suspended : the 
electric wires are broken, and association interrupted. 
Whatever is done to advantage must therefore be by appli- 
cations made directly to the part where the impression is 
wanted to be made ; and, happily, we possess the means of 
doing this in the present instance. Cold water may be 
thrown into the bowels by means of a large syringe, and 
operate with the same directness in cooling the internal 
surface as it will the external when applied to it. I will 
give a case in point illustrative of the benefit of this meas- 
ure, and of my general manner of procedure in managing 
cholera. 

The patient was a little daughter of Mr. Stewart, of the 
lower wharf, in this city. The cholera had, for several 
days, been raging in a very malignant form in the vicinity ; 
several had died suddenly the day of this attack : it was a 
violent one, and boded the worst consequences. The late 
Dr. B. McNairv attended the case with me, and after seve- 
rai hours' industrious effort, by means of small doses of 
calomel and opium, frequently repeated, and friction, mus- 



526 FUNCTIONAL DERANGEMENTS. 

tard, and chloroform liniment to the surface, etc., we suc- 
ceeded in obtaining a truce — the vomiting and purging and 
cramps subsided, and our little patient sank into a quiet 
slumber ; but the general features of the case indicated to 
the practiced eye of Dr. McNairy that this was only a lull 
in the storm — a suspension of active hostilities, in order to 
a rearrangement of the forces for a last and irresistible charge 
— and he so expressed himself to the friends, in order to 
prevent the indulgence of false hopes. By the by, this sus- 
pension of active evidence of the disease is not always to 
be claimed as the result of means that have been used, as 
it often takes place, as has been before observed, when 
nothing has been done. 

Seeing that nothing more could at present be done to ad- 
vantage in this case, we left to attend to other calls, but 
returned in about an hour. The child had slept quietly 
during that time, but now showed signs of restlessness ; 
and, upon examination, I found the extremities cold and 
nearly pulseless; the surface pale, the features pinched, 
and the abdomen distended and hard; I called for ice- 
water ; and, while it was being prepared, a spasmodic action 
of the bowels took place, which sent the rice-water dis- 
charge to some distance on the floor beyond the pallet on 
which the child lay, and a steam arose from it as from boil- 
ing water. I immediately threw up a pint of ice- water, 
which, in less than a minute, came back hot ; another and 
another syringe-full was thrown up, until the intervals of 
the discharge became longer, and the injected water came 
away cool. I then gave an injection composed of about 
two ounces of flour-gruel and twenty drops of laudanum, 
and made pressure upon the hips to prevent its being ex- 
pelled ; in a little time expulsive efforts ceased, and the 
child again fell into a quiet slumber, from which she awoke 
some hours after, much improved. The victory was now 
won ; nothing more was afterwards done, and a speedy re- 
covery took place. My good friend, the Doctor, did not 
return for some hours after — being engaged with those 
whom he supposed offered a better chance of being bene- 
fited by medical skill — and was much surprised to find 



JAUNDICE. 527 

that the patient was not dead, but presenting unmistakable 
symptoms of amendment, and remarked to the father that 
"this was an especial act of Providence." And so it was; 
but the cold water injections were the visible means by 
which he worked. 

I wish the treatment illustrated by the above case care- 
fully noted, as, though cholera may never come again — 
which God grant! — it is equally applicable to like conditions 
occasionally met with in congestive fever, and in other dis- 
eases in which profound depression is attended with wast- 
ing discharges from the bowels. 

Since the above was written the author has had the 
opportunity of testing the above plan of treatment during 
two visitations of cholera, and in his hands, and in those of 
other physicians who adopted it, it proved uniformly suc- 
cessful if adopted before fatal collapse had supervened. 

As most of the functional derangements of the liver have 
been sufficiently noticed in connection with diseases already 
treated on, it is unnecessary to refer to them again ; but 
there is one whose importance requires a more extended 
notice, viz., 

JAUNDICE. 

This is an affection in which the skin, eyes, and urine are 
of a yellow or yellowish color, from the presence of bilious 
matter. The color in jaundice is in all cases a mere symp- 
tom, occasioned by the presence of the coloring matter of 
bile in the blood. This may arise from either of the follow- 
ing causes : 

Excess of Production. — This probably happens in some 
instances of bilious fever, cholera, and diarrhoea, in which, 
along with a yellow color of the skin, eyes, and even urine, 
there is a bilious vomiting or purging. The same cause that 
produces the disease may occasion an increased production 
of the yellow principle, which, though escaping by the usual 
emunctory, is not thrown oif in that way with a rapidity 
corresponding to the exigencies of the system, and therefore 
finds other outlets. The same excess may sometimes occur 
34 



528 FUNCTIONAL DERANGEMENTS. 

as an original affection ; and then we shall have an attack 
of idiopathic jaundice, with bilious stools. 

Absorption. — This is believed by most to be an ordinary, 
and, by many, the exclusive source of jaundice. An ob- 
struction takes place in some portion of the biliary passages, 
which prevents the excretion of the bile. An accumulation 
of this fluid necessarily takes place in the gall-bladder or 
biliary passages behind the seat of obstruction ; and even 
the biliary tubes of the liver sometimes become greatly 
distended. It is supposed that the bile is now either ab- 
sorbed and conveyed into the circulation, or regurgitates 
directly into the venous radicles by which it was thrown 
out, and thus becomes excessive in the blood. Such ob- 
structions do undoubtedly sometimes exist in jaundice, and 
serve as the cause of it. But whether the bile reenters the 
circulation after having been once thrown out is not so cer- 
tain. A much more probable supposition is, that in cases 
of obstruction and consequent accumulation, the pressure 
made by the accumulated fluid upon the secreting vessels 
impedes this process, and thus prevents the due elimination 
of the yellow coloring matter from the blood. While, there- 
fore, I am willing to admit that absorption may contribute 
to the production of jaundice in cases of obstruction, I am 
also inclined to the opinion that, even in such, cases, defi- 
ciency of secretion is a more effective agent. 

Deficiency of Elimination. — Should the view taken of the 
existence of the yellow coloring matter of bile in the blood 
in health be correct, it follows that when the secretory 
action of the liver is either suspended, or diminished in a 
degree greater than that in which the coloring principle is 
produced, its accumulation in the circulation and its elimi- 
nation by other emunctories are necessary consequences. 
Such, I believe, is most commonly the origin of jaundice. 

Symptoms, Course, etc. — In most cases, the appearance of 
the characteristic phenomena of jaundice is preceded by 
symptoms indicative of functional disorder of the liver, and 
derangement of the digestive organs generally. Such are 
diminution or loss of appetite, sometimes nausea and vomit- 



JAUNDICE. 529 

ing, a vague and indescribable uneasiness in the epigastric 
and hypochondriac regions, a sense of sinking in the abdo- 
men, as if the bowels wanted support, a tendency to consti- 
pation, furred tongue, double or otherwise disordered vision, 
general disquietude, great and apparently causeless depres- 
sion of spirits, and a disposition to gloomy views of all 
subjects. These are not all present in all cases ; and in some 
instances most of them are wanting. If, after their appear- 
ance, the stools be examined, they will be found lighter 
than natural, perhaps at first of a light yellow hue, as in 
healthy infants, but afterwards whitish or grayish, like pot- 
ters' clay. 

At length the yellowness of the surface makes its appear- 
ance. In some instances, this is the first observable symp- 
tom. The color usually shows itself first in the eyes and 
face, afterwards upon the neck and upper part of the chest, 
and ultimately extends over the whole body, being most 
intense in those parts where the skin is thinnest and the 
perspiration most apt to appear, as upon the front of the 
trunk and on the insides of the extremities. At first, the 
color is usually a light yellow, sometimes a lemon yellow, 
which gradually deepens, and at length, if the disease con- 
tinues, is apt to assume an intense golden or deep orange 
hue, and this often covers the whole surface. Occasionally 
the yellowness is modified by a greenish tinge, and in some 
comparatively rare cases the color is so deep as to approach 
to blackness — a result which is probably owing in general to 
a depraved condition of the blood, such as occurs in scurvy. 
The affection thus characterized is sometimes called green 
or black jaundice. In ordinary cases, the yellow hue is 
often modified by the natural complexion of the patient, 
being lighter in the fair and deeper in the brown. The dis- 
coloration of the skin is occasionally attended with a very 
troublesome itching. 

The urine, which is at first little changed, after a time 
becomes yellowish or orange -colored, but with varying 
degrees of intensity, being sometimes little deeper in its 
tint than in health, but generally much darker, like a rather 
strong infusion of saffron, and occasionally deep-brown or 



530 FUNCTIONAL DERANGEMENTS. 

blackish. The darker hues are usually owing to a greater 
amount of the coloring matter; for the urine, if diluted, 
becomes bright yellow. The urine of jaundice may be dis- 
tinguished from that of nephritic affections by imparting a 
bright yellow stain to white linen. 

All the other secretions are occasionally more or less 
tinged with bile, especially the perspiration, which often 
stains yellow a towel rubbed upon the skin. The milk, 
however, is rarely affected, and the same may be said of 
the mucous secretion. The coating of fur on the tongue is 
often yellowish, and the patient frequently has a bitter taste. 
Though the conjunctiva is almost always deeply stained, the 
vision may remain unaffected. Sometimes, however, the 
coloring matter appears to be deposited in the humors of the 
eye, and then all objects are of a yellow hue. 

After the appearance of. the yellowness of skin and urine, 
I have often observed that the preliminary symptoms di- 
minish, though they still continue in a greater or less degree. 
The patient is still in general affected with epigastric unea- 
siness, more or less disorder of digestion, depression of 
spirits, general languor and indisposition to exertion, and 
other signs of nervous disorder. The bowels are usually 
costive, though sometimes regular, and in general readily 
moved by purgative medicine. The stools are in the great 
majority of cases whitish, gray, or clay-colored, from the 
absence of bile. Though the stomach is frequently disor- 
dered, and even nausea and vomiting sometimes occur, yet 
this is by no means invariably the case, the appetite being 
in some instances quite natural, and the digestion unim- 
paired. The tongue is sometimes furred, sometimes nearly 
or quite healthy in appearance. The skin is usually harsh 
and dry. The pulse varies much, being either quite natu- 
ral, irregular, or excited, and even febrile. 

The course of the disease is exceedingly various ; some- 
times rapid in its attack, and as quickly disappearing; it 
not unfrequently runs on for weeks and months, and, in 
some obstinate cases, may .even persevere for years. In the 
vast majority of cases, it either gets well spontaneously, or 
yields sooner or later to appropriate treatment. Indeed, 



JAUNDICE. 531 

fatal cases of jaundice are exceedingly rare, unless when it 
is complicated with incurable organic disease of the liver or 
adjacent viscera. The first sign of a favorable change is 
usually the reappearance of the healthy color of the stools, 
indicating a restoration of the secretion or excretion of bile. 
Simultaneously with this change, there is usually a great 
improvement in the symptoms of digestive and nervous 
disorder, indicated by a return of appetite, a disappearance 
of the epigastric uneasiness, and restored cheerfulness. 
This amelioration is often experienced before the discolora- 
tion of surface has been materially diminished. Gradually, 
however, the yellowness of skin, eyes, and urine disappears ; 
in general, receding last from the parts first attacked. 
The urine at this period frequently deposits a delicate red- 
dish sediment. 

Causes. — According to the views of jaundice already 
given, it may be produced by any cause which materially 
diminishes, or suspends altogether, the secretory function of 
the liver, whether by producing a torpor or a sort of 
paralysis of the organ, or by overwhelming its powers 
through the means of active congestion. The agents capa- 
ble of giving rise to these effects have been sufficiently 
treated of under other heads. (See Functional Diseases of 
the Liver, and Hepatitis.) Among the most frequent may 
be mentioned continued heat, miasmata, the depressing 
emotions, any sudden and violent passion, hysterical excite- 
ment, errors of diet, and gastric or duodenal affections 
operating through sympathy. The disease is said also to 
have sometimes prevailed epidemically. 

There is a variety of jaundice to which very young 
infants are liable. It comes on usually a few days after 
birth, and disappears in a short time, without any other 
observable disorder of system, unless perhaps a more than 
ordinary degree of drowsiness. It gives way almost always 
to gentle laxatives. 

Treatment. — In simple jaundice the most obvious indica- 
tion is to promote the hepatic secretion ; and, in the great 
majority of cases, this is all that is required. As soon as it 
is discovered, by an inspection of the alvine evacuations, 



532 FUNCTIONAL DERANGEMENTS. 

that the bile has fairly begun to flow, and that its flow can 
be sustained, a speedy cure may in general be calculated on 
with much certainty. 

In order to meet the indication properly, it should be 
ascertained, if practicable, whether the liver is in a state 
of active congestion or irritation, or whether it is torpid. 
If there be pain or a sense of fulness in the side, with 
tenderness on pressure, the former may be inferred ; full 
closes of some brisk purgative should be given, and emollient 
poultices, or cloths saturated in tepid water, applied to the 
region of the liver. 

But much more frequently there are no evidences of 
inordinate excitement of the liver, and the want of secre- 
tion must be ascribed to mere torpor, or a state of passive 
congestion. In this case, the treatment must be directed 
to the stimulation of the hepatic function. For this pur- 
pose a purgative dose of calomel should be given, to be 
followed in due time by a dose of castor oil. Instead of 
calomel alone, a combination of this with other active 
cathartics may be employed, as in the compound cathartic 
pill. Sometimes the more energetic action of an infusion 
of senna may be found advisable. After this, if the 
strength of the patient remain unimpaired, and the consti- 
pation with clay-colored stools continue, the cathartic may 
be repeated at intervals of two, three, or four days, until 
the flow of bile is established ; but, generally speaking, the 
alterative use of mercury alternated with laxatives will be 
preferable, as equally efficient and less exhausting to the 
patient. From half a grain to three grains of calomel, or 
one or two blue-pills, may be given every night or every 
other night, and followed in the morning by two drachms 
or half an ounce of epsom salts or cream of tartar ; the 
object being, in every case, to produce a slight stimulation 
of the liver, and a gentle action on the bowels, without any 
observable effect upon the gums, or any exhaustion of the 
strength. The disease will often yield to this simple plan. 
Should no evidence of a return of biliary secretion be 
observed in the course of a week or two, or should the 
symptoms at the commencement be urgent, it will be proper 



JAUNDICE. 533 

to resort to other measures. An emetic will often prove 
serviceable by compressing the liver, and, through its sym- 
pathies with the stomach, rousing it into action. Tartar 
emetic is preferable for this purpose. This remedy, how- 
ever, is disagreeable, and may generally be dispensed with. 
Small doses of various emetic medicines also prove service- 
able by stimulating the liver to secretion. 

There are other remedies supposed to have the cholagogue 
property, which may be used either as adjuvants of the 
mercurials, or as substitutes. The most efficient of these 
is nitro-muriatic acid, which may be used externally during 
the alterative mercurial course, and internally after it has 
been for some time suspended. The bark of the wild 
cherry, the dandelion, and soapwort have some reputation 
of the same kind, and are occasionally used. Aloes is 
thought by many to stimulate the liver directly, and is 
certainly a useful remedy in jaundice. Electricity may 
also be employed to rouse the torpid viscus. 

The narcotics are often highly beneficial by relieving 
nervous disorder, and producing sleep. Of these, hyoscya- 
mus and conium should be preferred to opium, which has a 
tendency to restrain the secretion of bile. They may, in 
general, be used quite freely ; but should not be employed 
when the head is materially affected. They may be used, 
among other purposes, for the alleviation of the disagree- 
able itching, which may also be allayed by gentle frictions 
with rye meal. The anodyne alterant (see Dyspepsia) given 
in tablespoonful doses three times a day, and blue-mass 
at night, have often succeeded after many other means had 
failed : a blister over the liver will aid other means in 
arousing the liver when torpid. When the disease is asso- 
ciated with organic affections of the liver or its appendages, 
the remedies suited to these affections must be resorted to. 
When jaundice exists along with bilious stools, indicating a 
probable excessive production of the coloring matter of bile 
in the circulation, the treatment should consist in the use 
of saline cathartics, and a vegetable diet. 

In obstinate cases of jaundice, and for completing the 
cure of those which have partially yielded to remedies, the 



534 FUNCTIONAL DERANGEMENTS. 

greatest advantage may be expected from a visit to the 
watering-places, especially to those in which the waters 
combine chalybeate and purgative properties. 

The diet must be accommodated to the circumstances of 
each case. When excitement exists, it should be confined 
to vegetable food, or to this with milk; but in most cases 
animal food is not only admissible but required. In all 
cases indigestible food should be scrupulously avoided. 
The regimen suited to dyspepsia is also, as a general rule, 
the best in jaundice not complicated with inflammation. — 
{See Dyspepsia.) 

INFANTILE JAUNDICE. 

Very young infants not unfrequently have a form of 
jaundice which, though usually not a serious disease, often 
causes much maternal anxiety. I think the best remedy, 
and the only one which I use, is small doses of calomel. 
No medicine acts so mildly and safely in many of the dis- 
eases of infancy as calomel It should be given in doses of 
half a grain to a grain, and repeated every three or four 
hours until relief is obtained. 



CATARRH. 535 



CHAPTER II. 

FUNCTIONAL DERANGEMENTS CONNECTED WITH RESPIRATION. 



CATARRH COMMON COLD. 

My readers are all familiar with the symptoms charac- 
terizing cold. The most prominent are, lassitude, sense of 
chilliness, a feeling of tightness across the forehead, head- 
ache, pains in the back and limbs, a hot watery secretion from 
the eyes and nose, hoarseness, sore-throat, cough, etc. The 
chief causes are, sudden changes of temperature, exposure 
to a damp cool atmosphere after fatigue or having been 
confined to a close room, cold and dampness to the feet, sit- 
ting in a current of air, etc. 

Everybody knows how to treat a cold — at least, they 
suppose they do ; and yet no disease is oftener mis- 
treated ; and as this frequently leads to the development of 
very serious forms of disease, it becomes important that 
correct rules should be understood for its management. 
When we recollect that catarrh is ushered in with the 
same symptoms which attend the forming stage of most 
fevers, and often presents in its course all the distinctive 
phenomena attending a paroxysm of fever, it follows as a 
reasonable conclusion that the condition of the system is 
also similar, which my readers have already been frequently 
informed consists essentially in nervous disturbance and 
capillary inaction, which leads to capillary congestion, fol- 
lowed by arterial reaction. I would therefore refer the 
reader to the article on Fever for full information as to the 
condition of the system and the best means for removing it. 



536 FUNCTIONAL DERANGEMENTS. 

But, usually, catarrh requires no treatment, the efforts of 
nature being fully able to bring about a perfect restoration 
of health in a few days ; yet many simple means may 
easily be brought to bear in aid of the vital powers, and 
thus lighten the task and insure success. A teaspoonful 
of Bateman's drops, or paregoric, or fever syrup, taken every 
two or three hours, and some mild tea, as garden sage, 
wild sage, balm or spicewood, drunk plentifully, a hot 
mustard foot-bath, and chloroform liniment to the spine 
and chest, will usually effectually break up a cold in a 
very few hours. When there is great irritation of the 
nose and eyes, saturating a corner of your handkerchief 
with chloroform liniment, and holding it to your nose while 
breathing, will often afford prompt relief, and will open the 
nostrils when the swelling of the sniderean membrane has 
obstructed the passage of the air. If there be much cough 
and little expectoration, ten grains of Dover's powder may 
be added to a cupful of one of the teas mentioned, and 
drank on going to bed. 

A cold should never be suffered to continue long, as it 
will get up permanent morbid changes that may become 
very difficult of removal. Frequent bathing, or sponging 
with cold water, will be found of great advantage by those 
who easily contract colds. 

INFLUENZA EPIDEMIC CATARRH GRIPPE . 

The name influenza has been applied to an epidemic dis- 
ease which usually takes on the character of catarrh. At the 
moment of invasion, it seizes almost simultaneously on 
great numbers, and before its departure sometimes involves 
almost the whole population. Its average duration, in each 
neighborhood, is about six weeks ; though the cause appears 
to linger after all the susceptible material for its action has 
been exhausted; for strangers arriving in the affected 
region, after the disease has apparently ceased, are not un- 
frequently attacked. The inferior animals appear to suffer 
as well as man. Many instances are on record, in which 
horses, dogs, sheep, and even birds, have been attacked by 
the epidemic. Some persons are much less susceptible to 



INFLUENZA. 537 

the morbid influence than others, and some appear to be al- 
together insusceptible. No obvious cause exists for this 
discrepancy. All ages, both sexes, and every variety of 
temperament and occupation, are equally liable to attack. 
It has been estimated that from one-half to three-quarters 
of the community are in a greater or less degree affected. 

The disease exhibits, on the whole, a remarkable uni- 
formity of character, though it has occasionally differed 
much in its grade of severity, in different times and places. 
In general it is very mild ; but on some occasions, and in 
certain localities, it has proved extremely fatal. Thus, dur- 
ing the epidemic of 1580, nine thousand persons are said to 
have died of the disease in Home. It is probable that 
other epidemic influences may occasionally combine with 
and modify it in certain situations. It may, for example, 
be readily conceived that, if it should make its appearance 
in a neighborhood already tainted with a typhoid influence, 
it might fearfully increase the mortality. 

In many of the epidemics, authors have recorded unu- 
sual changes in the temperature, moisture, and weight of 
the atmosphere ; but the same state of the weather has not 
been observed in different places attacked ; and not unfre- 
quently there has been nothing uncommon noticed. It ap- 
pears that the disease has prevailed in all climates, at all 
seasons, and in every possible thermometrical, hygrometri- 
cal, and barometrical variation. It has sometimes occurred 
in summer, though more frequently in the colder seasons. 

Symptoms. — Influenza usually appears with the ordinary 
symptoms of catarrh or common cold, upon the whole, in a 
rather aggravated form. In many instances, however, it is 
very light, without fever, and scarcely regarded by the 
patient. It usually begins with coryza or sore-throat, and 
the common preliminary symptoms of fever, as feelings of 
lassitude and weariness, pains in the limbs, chilliness, rigors, 
etc., which are followed first by heat of skin, headache, and 
excited pulse, and soon afterwards by cough, uneasiness in 
the chest, and other signs of pectoral disease. But the 
symptoms of nervous derangement are in general much 
more prominent than in ordinary catarrh, and there is 



53 S FUNCTIONAL DEKANGEMENTS. 

greater muscular debility. Disorders of sight and hearing, 
giddiness, pains in the back and limbs, general uneasiness, 
and depression of spirits, are not uncommon in this disease. 
The headache is often severe, sometimes affecting equally 
the whole head, but more frequently concentrated in the 
forehead, and especially in the region of the frontal sinuses. 
Not unfrequently the pains extend to the back of the neck, 
in the form of rheumatism, and to the cheeks and temples, 
which are very sore and painful. Disorders of stomach, 
such as nausea and vomiting, are more common than in 
ordinary catarrh. But the most distinguishing feature of 
the disease is the debility which attends it. As in ordinary 
catarrhal fever, there is generally a remission of the febrile 
symptoms in the morning, and an exacerbation towards night. 

Epidemic catarrh has usually the same course and dura- 
tion as the disease from ordinary causes. It generally ter- 
minates favorably by perspiration, copious mucous secretion 
from the bronchia, or increased discharge of the urine, 
which deposits a sediment on standing. Pustular eruptions, 
erysipelas, and scarlet rashes, are enumerated among the 
phenomena which occasionally occur at the close of the 
complaint. The duration of the disease varies from two or 
three days to one or two weeks ; and a cough is frequently 
left after the other symptoms have disappeared. The fever 
probably, in most cases, goes off about the fifth day, with 
copious sweating or expectoration. 

Epidemic catarrh is very seldom a dangerous disease. It 
is scarcely ever fatal, unless complicated with other diseases. 

Treatment. — In relation to the treatment it is necessary 
to say but little. The disease must be managed in the same 
way essentially as common catarrh. Eupatorium or bone- 
set has long been recommended in this disease. I have 
employed it in many cases exclusively, and found it useful 
by its sudorific, laxative, and emetic properties, when ad- 
ministered early in the complaint, in the form of warm in- 
fusion ; and by its tonic powers when given in cold infusion, 
in the advanced stasre. When diarrhoea occurs in the latter 
stages, it may be arrested by means of Dover's powder or 
paregoric. When the debility is considerable, it is often 






WHOOPING-COUGH. 539 

necessary to support the system by tonics, aromatics, and 
even more powerful stimulants. 



WHOOPING-COUGH, OR PERTUSSIS. 



This is a contagious disease, characterized by frequent 
paroxysms of coughing, in which the expiration is broken 
into numerous short, rapid, and spasmodic movements, and 
the inspiration is long, and frequently sonorous. It most 
frequently affects young children. Medical writers usually 
divide it into three stages : 1, the catarrhal or forming 
stage ; 2, the spasmodic instance, or that of progress and ma- 
turity; and, 3, the declining stage. The limits of these 
several stages are not always well defined, nor do they all 
exist in every instance of the disease. Something like them, 
however, is very generally observable ; and the division 
enables the symptoms to be more conveniently grouped in 
description, than they could be without this or some similar 
arrangement. 

Symptoms, Course , etc. — The disease generally begins, 
like a common cold, with coryza, running at the nose, red 
and watery eyes, sneezing, irritation of throat, a dry cough, 
and sometimes febrile symptoms ; and it is often impossible 
to distinguish it, with certainty, at this period, from catarrh 
or common cold. The cough, however, has usually more 
of a paroxysmal character ; and this circumstance, in con- 
nection with the fact that the disease is prevalent at the 
time, is sufficient to fix suspicion upon the case, and put 
the practitioner upon his guard. This stage continues, in 
most cases, for one or two weeks, before decided spasmodic 
symptoms appear. Sometimes, however, its duration is 
shorter, and sometimes longer. Instances, indeed, now and 
then occur, in which the characteristic symptoms of the 
disease appear at the outset ; and it is occasionally observed, 
during the prevalence of whooping-cough, that catarrhal 
affections run a corresponding course, as if dependent upon 
the same cause, though destitute of the peculiar spasmodic 
phenomena. 

But, in most cases, at the end of eight or ten days, the 
cough begins to change, gradually assuming the proper 



540 FUNCTIONAL DERANGEMENTS. 

character of pertussis ; and the disease passes into the 
second stage. This, when fully formed, presents the fol- 
lowing symptoms. At irregular intervals through the day 
and night, the child is seized with an irresistible disposition 
to cough. But the sound, instead of occupying continu- 
ously the whole time of expiration, as in ordinary com- 
plaints of the chest, is broken into a number of short 
coughs, which succeed each other with an almost convulsive 
force and rapidity; and the inspiration that immediately 
follows is long, difficult, and often attended with a shrill or 
whooping sound, which has given its common name to the 
complaint. This succession of spasmodic cough and shrill 
inspiration is repeated again and again, thus constituting a 
paroxysm, which lasts variously from thirty seconds to fif- 
teen minutes, or even longer. During the paroxysm, the 
face is flushed, swollen, and sometimes purplish or livid, the 
veins of the neck and temples distended, the eyes promi- 
nent, and the countenance expressive of much distress. 
The child, if lying, starts up into the sitting posture, and, 
if standing, seizes some person or object near him for sup- 
port. In violent cases, the blood sometimes escapes from 
the nose, mouth, or ears, or is extravasated into the tissue 
of the conjunctiva ; and the urine and faeces are discharged 
involuntarily. The paroxysm usually terminates with 
the expectoration of transparent mucus, and not unfre- 
quently in vomiting, which appears to relax the spasm, and 
thus proves serviceable in the complaint. Occasionally, 
however, no discharge takes place from the lungs or stomach, 
and the paroxysm ceases with the exhaustion of the pa- 
tient. For a short time after it is over, the child appears 
feeble and perhaps trembling, with hurried pulse and breath- 
ing ; but he soon recovers from these symptoms, and seems 
as if nothing had happened, resuming his play or occupa- 
tions with his ordinary cheerfulness, and often showing an 
eager desire for food, especially after vomiting. If asleep 
when seized with the cough, he lies down when it is passed, 
and is soon asleep again. 

The paroxysms increase in frequency and violence until 
the complaint is at its height, which is usually in three or 



WHOOPING-COUGH. 541 

four weeks from the commencement of the attack, though 
the time may be considerably shorter or longer. The dis- 
ease then appears to remain stationary for about two or 
three weeks, after which it begins to decline, and the third 
stage commences. The spells of coughing now gradually 
become less frequent and severe, and more catarrhal, being 
attended with the expectoration of opaque whitish or yel- 
lowish matter, and losing much of the spasmodic or convul- 
sive character. At length the broken expiration and the 
whooping sound cease entirely, and the patient is either 
well, or affected with a slight ordinary cough, which in its 
turn ceases. 

The force of the disease varies much, even in its simple 
form. In some instances it is so slight that it can scarcely 
be determined, after recovery, whether the child has had 
whooping-cough or not. In others again it is very severe, 
with frequent and violent paroxysms, which seem to threaten 
suffocation. By the pressure upon the brain, fatal convul- 
sions are sometimes brought on ; and death may also take 
place from asphyxia during the paroxysm. In protracted 
cases, great emaciation and debility sometimes ensue, and 
the patient may die of exhaustion. But these results are 
comparatively rare. The simple form of the disease almost 
always terminates favorably. It is, however, liable to com- 
plications, which are very often dangerous, and not unfre- 
quently fatal. 

Different opinions have been entertained of its contagious 
nature ; but the great majority of writers are united in 
believing that it is propagated from individual to individual ; 
and it does not appear possible to the author to resist the 
weight of evidence in favor of this view. It is probably 
most contagious at the period of its highest development. 

As a general rule, the disease occurs only once in the 
same person. Exceptions occasionally occur to this rule, 
as in all other contagious diseases. It is confined to no age, 
sex, or condition of life. Persons advanced in life are some- 
times attacked, and Dr. Watson mentions a case in which a 
child was born with it. For a very obvious reason, how- 
ever, it is confined chiefly to early childhood. Being fre- 



542 FUNCTIONAL DERANGEMENTS. 

quently prevalent, and highly contagious, it attacks most 
persons early in life ; and adults escape because they have 
once had the disease. It is said to affect infants less fre- 
quently before than after the commencement of dentition. 
But may not this be owing to the fact that, upon the whole, 
very young infants are less exposed to the cause ? 

Treatment. — In simple cases of whooping-cough, without 
violent symptoms, little treatment is requisite. In its se- 
verer forms, however, treatment is often highly useful in 
alleviating the symptoms, and, in complicated cases, is fre- 
quently indispensable to safety. 

In the early stage, if the catarrhal symptoms are mode- 
rate, it will be sufficient to give a mild cathartic, as castor 
oil, magnesia, or the sulphate of magnesia, and afterwards 
small doses of ipecacuanha or antimonial wine, at short 
intervals. 

When the spasmodic symptoms appear, different remedies 
are required. Emetic medicines are useful by relaxing the 
spasm, depressing general arterial excitement, and promoting 
expectoration. They may be aided by the frequent use of 
hot pediluvia, [foot-bath,] or the warm bath. When fever 
has disappeared, and the proper paroxysms of whooping- 
cough only remain, recourse may be had to the antispas- 
modics. 

By far the best of the nervous stimulants that I have 
employed is assafoetida. It should be given in emulsion, in 
the dose of one or two grains to a child two years old, re- 
peated three or four times a day, or, in severe cases, as often 
as every two or three hours. Though disagreeable at first, 
it soon ceases to be so ; and it is not at all uncommon to 
see the little patient anxious for the repetition of his dose. 
Garlic may often be very happily employed as a substitute 
for assafoetida, when this may not be at hand, or may, from 
any cause, be forbidden. Other antispasmodics, which have 
had more or less reputation in the complaint, are musk, 
castor, valerian, camphor, ammonia, oil of amber, and cochi- 
neal. 

Vaccination appears, in some instances, to have exercised 
a decided influence in modifying or arresting the disease ; 



WHOOPING-COUGH. 543 

and may therefore be resorted to in cases in which the child 
has not yet undergone this process. 

In the declining stage of the disease, the same remedies 
may be employed as previously, in gradually diminishing 
quantities, as the peculiar symptoms decline. Should a 
troublesome cough remain, in this stage, it may be treated 
with the stimulant expectorants, combined with opium or 
hyoscyamus, as in chronic bronchitis. Debility must be 
counteracted by the moderate use of tonics. But what is 
chiefly required, is care to avoid causes of inflammatory 
attacks, to which the child is now very incident. 

Should convulsions occur in the course of the complaint, 
without fever, heat of head, or other signs of dangerous 
cerebral disease, assafcetida should be given by injection, 
garlic poultices applied to the feet, frictions with garlic and 
brandy made along the spine, and the body immersed, if 
necessary, in a warm bath. 

The diet should vary with the stage and the degree of ex- 
citement. It should consist, in the early stage, chiefly of 
vegetable substances, with or without milk ; at a more ad- 
vanced period, of the same materials, with milk freely, and 
a little of the lightest kind of meat, as the boiled breast of 
fowl, soft boiled egg, etc. ; and, in the end, when the patient 
is debilitated, of the most nutritious food. Whatever is 
taken should be of easy digestion. Should inflammation at 
any time supervene, the diet should be strictly vegetable. 
The child should always be clothed with flannel next the 
skin. In the catarrhal stage, he should be confined to a 
uniform temperature ; but, when the disease has become 
purely spasmodic, frequent exposure to fresh, dry air, even 
in winter, is not only allowable, but often highly useful. 
Damp should always be avoided. In protracted cases, or 
those with a tedious convalescence, the cure is much pro- 
moted by change of residence, as from town to the country, 
or from one part of a town to another ; and, in the winter 
season, great good may be expected from removal to a warm 
climate. 

35 



544 FUNCTIONAL DERANGEMENTS. 



ASTHMA. 

This disease is a spasmodic affection of the lungs, which 
comes on by paroxysms most generally at night, and is 
attended by a frequent, difficult, and short respiration, to- 
gether with a wheezing noise, tightness across the chest, 
and a cough ; all of which symptoms are much increased 
when the patient is in a horizontal position. 

Asthma rarely appears before the age of puberty, and 
seems to attack men more frequently than women, particu- 
larly those of a full habit, in whom it never fails, by frequent 
repetition, to occasion some degree of emaciation. Dyspep- 
sia always prevails, and appears to be a very prominent 
feature in the predisposition. Its attacks are most frequent 
during the heats of summer, and in winter, when heavy 
fogs or sharp cold winds prevail. 

When the disease is attended with an accumulation and 
discharge of humors from the lungs, it is called the humid 
asthma ; but when it is unaccompanied by any expectora- 
tion, it is known by the name of the dry or spasmodic 
asthma. 

On the evening preceding an attack of asthma, the spirits 
are often much affected, and the person experiences a sense 
of fulness about the stomach, with lassitude, drowsiness, 
and pain in the head. Qn the approach of the succeeding 
evening, he perceives a sense of tightness and stricture 
across the breast, and a feeling of straitness in the lungs, 
impeding respiration. The difficulty of breathing continu- 
ing to increase for some length of time, both inspiration and 
expiration are performed slowly, and with a wheezing noise ; 
the speech becomes difficult and uneasy, a propensity to 
coughing succeeds, and the patient can no longer remain in 
a horizontal position, being, as it were, threatened with im- 
mediate suffocation. 

These symptoms usually continue till towards the approach 
of morning, and then a remission commonly takes place ; 
the breathing becomes less laborious and more full, and the 
person speaks and coughs with greater ease. If the cough 



ASTHMA. 545 

Is attended with a free expectoration of mucus, he expe- 
riences much relief, and soon falls asleep. 

When he awakes in the morning, he still feels some de- 
gree of tightness across his breast, although his breathing 
is probably more free and easy, and he cannot bear the least 
motion without rendering this more difficult and uneasy ; 
neither can he continue in bed, unless his head and should- 
ers are raised to a considerable height. 

Towards evening he again becomes drowsy, is much trou- 
bled with flatulency in the stomach, and perceives a return 
of the difficulty of breathing, which continues to increase 
gradually till it becomes as violent as on the night be- 
fore. 

After some nights passed in this way, the fits at length 
moderate, and suffer more considerable remissions, particu- 
larly when they are attended by a copious expectoration in 
the mornings, and when this continues from time to time 
throughout the day ; and the disease going off at last, the 
patient enjoys his usual rest by night without further dis- 
turbance. 

During the fits the pulse is not usually much affected, 
but in a few cases there is a frequency of it, with some de- 
gree of thirst, and other febrile symptoms. In some persons 
the face becomes turgid and flushed during the continuance 
of the fit, but more commonly it is pale and shrunk. Urine 
voided at the beginning of a fit is generally in considerable 
quantity, and with little color or odor ; but after the fit is 
over, what is voided is in the ordinary quantity, of a high 
color, and sometimes deposits a sediment. 
1 Asthma, but more particularly the spasmodic, is brought 
on by almost every thing which increases the action of the 
heart, and which stimulates and fills the vessels of the mu- 
cous membrane. Thus, it is produced by intense heat, by 
lightness of air, by severe exercise, by strong mental emo- 
tions, by full meals, by stimulating drinks, by exposure to 
cold and atmospherical influence, and by certain effluvia, as 
those of hay, whether new or old, of sealing-wax, and other 
burning substances. 

Congestions of blood, noxious vapors, impure and smoky 



546 FUNCTIONAL DERANGEMENTS. 

air, cold and foggy atmosphere, sudden changes of tempera- 
ture, scrofulous, rheumatic, gouty, and scorbutic acrimony ; 
dyspepsia or irritation in some of the abdominal viscera, 
but particularly in the stomach ; irritation of the bronchial 
system, suppression of long-accustomed evacuations, frequent 
catarrhal attacks, erratic gout, general debility, water in the 
chest, aneurisms, polypi, and the like, are the causes from 
which this formidable disease may arise in different individ- 
uals. In some instances it proceeds from a hereditary pre- 
disposition, and in others from mal-conformation of the 
chest. 

Asthma having once taken place, its fits are apt to return 
periodically, and more especially when excited by certain 
causes, such as by a sudden change from cold to warm 
weather, or from a heavier to a lighter atmosphere ; by 
severe exercise of any kind which quickens the circulation 
of the blood ; by an increased bulk of the stomach, either 
from too full a meal, or from a collection of air in it ; by 
exposures to cold, obstructing the perspiration, and thereby 
favoring an accumulation of blood in the lungs ; by violent 
passions of the mind ; by disagreeable odors ; and by irri- 
tations of smoke, dust, and other subtle particles floating in 
the air. 

A consequence of 'convulsive motions is the habit of 
repetition the muscles have contracted by laws peculiar to 
the animal economy; so asthma is believed to depend fre- 
quently upon this cause. 

The proximate or immediate cause of the disease has by 
Dr. Cullen and most other writers been supposed to be a 
preternatural or sjDasmodic constriction of the muscular 
fibres of the bronchise, which not only prevents their being 
so dilated as to admit of a free and full inspiration, but also 
gives them a rigidity which interferes with a free and full 
expiration. 

Asthma usually diminishes as soon as a mucous secretion 
begins to take place. 

The sudden accession of the paroxysms, generally after 
the first sleep, their returning at intervals, and the sense of 
constriction about the diaphragm, occasioning the patient to 



ASTHMA. 547 

get into an erect posture, and to fly for relief to the cold 
air, will readily distinguish asthma from other diseases. 

Prognosis. — Asthma is occasionally cured, and more fre- 
quently relieved ; but, in the great majority of cases, after 
being once established, it continues with a more or less 
frequent recurrence of the paroxysms until the close of life. 
When uncomplicated, it is almost never fatal, notwithstand- 
ing its apparent violence ; but it is not unfrequently asso- 
ciated with fatal diseases ; and there is reason to believe 
that it sometimes produces them, and is thus the remote 
cause of death. A judgment, therefore, as to its results in 
any particular case must be founded on the character of the 
attendant diseases. 

Treatment. — There are two prominent indications in the 
treatment of asthma : one to relax the spasm, the other to 
correct the predisposition. The former is presented in the 
paroxysm, the latter in the interval. 

One of the most effectual means of producing relaxation 
is the use of emetic substances. These may be given so as 
to vomit, or merely to sustain a considerable degree of 
nausea. Ipecacuanha is perhaps most employed. It may 
be given in the full emetic dose, and afterwards, if deemed 
necessary, in small doses, so as to nauseate. Lobelia, too, 
has great reputation, and is certainly in some instances very 
effectual, though it fails, as every remedy is liable to do, in 
others. I think I have derived more advantage from it 
than from any other single remedy. Tartar emetic and 
squill have also been employed. In severe cases, when the 
breathing is so obstructed as to threaten immediate death, a 
teaspoonful of ground mustard given in a pint of warm 
water will afford the most speedy relief. The emetic and 
nauseating treatment generally is best adapted to the dis- 
ease when associated with a degree of bronchial inflamma- 
tion. 

Antispasmodics are often very useful in the purely spas- 
modic cases. Sulphuric ether, assafoetida, and musk are 
among the most effectual, and they are often usefully asso- 
ciated with one of the salts of morphia. They are especially 
beneficial in hysterical cases. Strong coffee is also much 



548 FUNCTIONAL DERANGEMENTS. 

employed, and is often serviceable. It should be saturated, 
and a cupful taken every twenty or thirty minutes. As it 
loses its effects somewhat upon repetition, it is a good plan 
to abstain from its habitual use at meals. 

Certain narcotics have been much and beneficially em- 
ployed. Some caution, however, is requisite in their use. 
Stramonium, or Jamestown weed, is the one which enjoys 
the highest reputation. It is employed almost exclusively 
hy smoking the dried leaves or stems, like tobacco. The 
relief which it affords is sometimes great and immediate. 
It is most efficient when used at the commencement of the 
paroxysm. The smoking of tobacco also occasionally affords 
great relief. Opiates are very useful in the purely spas- 
modic cases, without tendency to cerebral disease. The 
salts of morphia are perhaps preferable to the other pre- 
parations. They may often be usefully associated with the 
other medicines employed, as with sulphuric ether and 
colchicum. 

Besides the three classes of medicines above mentioned, 
many other remedies have been used with greater or less 
advantage in the paroxysm. The application of electricity 
or electro-galvanism has occasionally arrested it. The same 
may be said of cold water, dashed in the quantity of a 
pailful over the shoulders. The simultaneous use of cold 
drinks and hot pediluvia has been recommended. Sinapisms 
or other powerful rubefacients to the chest sometimes afford 
relief; but there is danger that some of the more volatile 
substances of the class may increase by their vapors the 
sense of suffocation. The inhalation of the fumes of burn- 
ing paper, previously impregnated with a saturated solution 
of nitre and dried, is asserted to be sometimes very effect- 
ive. It is best that the paper should have been dipped a 
second time into the solution and dried. It may be either 
burned in the chamber or smoked by means of a pipe ; but 
nothing has afforded in our hands such prompt relief as 
bathing the spine and chest with the chloroform liniment. 
In cases attended with spinal tenderness, cups or leeches 
should be applied over the tender vertebrae, and followed in 
due time by strong ammonia, a fly-blister, or tartar emetic 



ASTHMA. 549 

ointment. The apartment should be well aired ; all articles 
of dress that in any degree restrain the movements of the 
chest should be removed ; as few assistants as will answer 
the purposes of attendance should remain in the room, and 
smoke and other exhalations should be carefully avoided. 

In the interval, our efforts should be directed to the 
removal of the morbid tendency; and, for this purpose, 
every discoverable deviation from health should be corrected 
as far as possible. It is impossible to particularize all the 
remedies that may be employed. The attention should be 
directed particularly to the state of the stomach and bowels. 
Dyspeptic symptoms may require antacids, carminatives, 
and tonics ; constipation, laxatives ; deranged hepatic secre- 
tion, the mercurial alteratives. In the female, the menstrual 
function should be kept in order. In gouty cases, moderate 
doses of colchicum may be found beneficial. Anemia and 
general debility must be counteracted by tonics and a suita- 
ble regimen. If chronic bronchial inflammation exist, it 
should be treated with local depletion, blistering, the stimu- 
lating and nauseating expectorants, etc. Any remains of 
the spasm connected with the inflammation may be advan- 
tageously treated with tincture of lobelia, associated with 
ipecacuanha wine or syrup, the tincture or syrup of squill, 
or the syrup of seneka. In some cases, the metallic tonics 
which prove useful in nervous affections, as chorea, epilepsy, 
hysteria, and neuralgia, have the effect of interrupting or 
postponing the paroxysms. For this purpose may be em- 
ployed subnitrate of bismuth, the oxide and sulphate of 
zinc, ammoniated copper, nitrate of silver, and the chalybe- 
ates, which may sometimes be conjoined with small doses 
of opium. When the paroxysms occur at precisely regular 
intervals, with complete intermission, there will be some 
chance of interrupting them by sulphate of quinia. Strong 
moral or physical impressions of any kind will sometimes 
avert them. Dr. Lefevre, a French physician, who published 
a paper on asthma, used frequently to set aside a paroxysm 
in his own case by having his bed heated, or heating him- 
self before a fire. 

The diet should be easy of digestion and nutritious, yet 



550 FUNCTIONAL DERANGEMENTS. 

not stimulating. Qaution should be particularly observed 
not to overload or distend the stomach. Alcoholic drinks, 
as well as the habitual use of tea and coffee, should be for- 
bidden. Advantage will sometimes accrue from the daily 
use of the shower-bath, or sponging the chest with cold 
water or salt and water; but these means should not be 
employed unless followed by immediate reaction. Exercise 
is highly useful, especially on horseback. The place of abode 
should be chosen in reference to the particular experience 
of the patient, that being preferred which is found to suit 
him best. As a general rule, a mild equable climate, neither 
very moist nor very dry, is the most favorable. Travelling 
is sometimes highly advantageous. In this, as in other 
habitual nervous affections, it may be found useful to sur- 
round the patient with entirely new circumstances, so that 
a new set of impressions may be made on his nervous sys- 
tem. A long voyage, or a protracted journey abroad, would 
offer some hope of a permanent cure when no organic disease 
existed. 

INFANTILE SPASM OF THE GLOTTIS CROWING DISEASE 

INWARD FITS. 

This disease, though similar to catarrhal croup in some 
of its synrptoms, is essentially distinct in the circumstance 
that it is purely nervous, and independent of vascular irri- 
tation. The affection is usually characterized by a shrill 
sound in inspiration, somewhat like the crowing of a cock, 
which has given origin to the name of crowing disease. The 
sound is owing to a spasmodic contraction of the chink of 
the glottis ; and the complaint is confined to infancy and 
very early childhood, occurring at any time from a few days 
after birth to the end of the third year, but most frequently 
during the period of the first dentition. Hence the name at 
the head of this article. 

Symptoms. — The attack is sudden, and may occur at any 
time, though it is most frequent during sleep, from which 
the child awakes with a start, and in great apparent alarm. 
He is seized with inability to inhale the air ; and the first 
symptoms are those of a struggle for breath, with the head 



INFANTILE SPASM OF THE GLOTTIS. 551 

thrown back, the breast elevated, the nostrils expanded, the 
mouth open, and all the muscles of inspiration in almost 
convulsive action. The veins of the neck and head are 
distended; and the countenance is flushed, swollen, and 
purplish, or of a pale, cadaverous hue, with an expression 
of extreme anxiety and distress. At length, but occasion- 
ally not until symptoms of asphyxia appear, the spasm of 
the glottis somewhat relaxes, and the air rushes in, with a 
shrill, whooping sound. The child then usually begins to 
cry, and, after a short period of hurried breathing, returns 
to his previous health. Not unfrequently, along with the 
difficulty of inspiration, there is a spasmodic contraction of 
the fingers and toes ; and the paroxysm is sometimes fol- 
lowed by general convulsions. When the a/ttack is over, 
the child is free from all symptoms of disease of the throat. 
Occasionally only a single paroxysm occurs at first, and the 
disease does not return for weeks. But the interval is 
often much shorter; and, in bad cases, the attacks take 
place several times a day, increasing in duration and fre- 
quency, until they occupy a quarter or half an hour at a 
time, and sometimes scarcely have an appreciable inter- 
mission between them. 

The complaint is usually unattended with cough, fever, 
bronchial disease, or any appreciable inflammation of the 
larynx or trachea. By the absence of these affections it 
may be readily distinguished from croup. 

Though often a trifling disease, it is sometimes far other- 
wise. In some instances the child perishes with asphyxia, 
from the persistence of the spasm. 

Causes. — The disease appears to depend upon a morbid 
excitability of the nervous system, directed especially to 
the muscles of the glottis, which contract spasmodically 
from slight causes, such as the sudden contact of cold air, 
any quick unexpected movement, or vivid mental emotion, 
especially fright. Hence infants are sometimes attacked 
with it when tossed playfully in the air. The act of 
swallowing occasionally brings on an attack. This morbid 
nervous irritability is most frequently owing to dentition ; 
but it may also be produced by other causes which dete- 



552 FUNCTIONAL DERANGEMENTS. 

riorate the general health, such as impure and confined air, 
unwholesome food, worms, etc. 

Treatment. — It is sometimes highly important lo relax 
the spasm of the glottis at the commencement of the 
paroxysm, so as to prevent asphyxia. This may generally 
be accomplished by dashing cold water upon the face or 
shoulders, gently slapping the back, or blowing into the ear. 
When the spasm recurs frequently, it may often be pre- 
vented by the warm bath, nauseating medicines, and anti- 
spasmodics injected into the rectum. Should the symptoms 
be alarming, tobacco should be applied to the throat in the 
form of a snuff plaster. 

The general nervous excitability in which the complaint 
sometimes originates, should be controlled by the nervous 
stimulants, which have the property of equalizing the 
excitement. For this purpose, assafoetida or valerian may 
be given internally, and garlic applied in the form of cata- 
plasm to the feet, or with hot brandy to the spine. Tonics 
and the cold bath, when the latter does not induce the 
spasm by the alarm it produces, are also useful by giving 
strength to the nervous system. 

Attention should always be paid to the state of the 
gums, which should be lanced if swollen and painful. 
When the dentition is peculiarly difficult and painful, blis- 
ters may be applied behind the ears, or at the nape of the 
neck. 

The bowels should also be scrupulously attended to. If 
the stools are white, or otherwise disordered from deranged 
biliary secretion, minute doses of calomel should be given, 
or mercury with chalk, if there is diarrhoea. Acidity must 
be corrected by the usual remedies. Should a tendency to 
constipation exist, it must be counteracted by rhubarb, 
magnesia, castor oil, or other mild cathartic, so as to obtain 
one or two stools daily. The diet should be very carefully 
regulated, and all indigestible or acescent food forbidden. 
The mother's milk is usually the best, food under the year, 
and cow's milk with arrowroot, ground rice, etc., and animal 
broths in moderation afterward. The child should be 
clothed warmly, and made to breathe a free and pure air. 



APHONIA. 553 

Special care should be taken to avoid all frights, or other 
sudden or violent emotions. 

SPASM OF THE GLOTTIS IN ADULTS. 

Occasionally the glottis is spasmodically affected in 
adults, independently of inflammation. The same phe- 
nomena to a certain extent occur as in children. There is 
first difficulty with laborious effort in inspiration, then the 
si) rill whooping sound arising from the entrance of air 
through the somewhat opened but still contracted passage, 
and occasionally a croupy cough. The spasm may be 
excited, and sometimes fatally, by a foreign body in the 
larynx or pharynx. * Choking is in such cases not mecha- 
nical ; but arises from involuntary contraction of the laryn- 
geal muscles, consequent upon irritation of parts supplied 
with branches of the same nerves. The affection results 
most frequently from an unstable and excitable condition 
of the nervous system, and is merely one of the protean 
forms in which hysteria exhibits itself. Sometimes it 
appears to have its origin in spinal, sometimes in cerebral 
irritation. It is much more common in women than in 
men. 

The treatment must be directed to the cause, and is for 
the most part such as is adapted to cases of hysteria. 
Antispasmodics, narcotics, tonics, the cold or shower-bath, 
a proper regulation of the intestinal and uterine functions, 
counter-irritation to the spine, an appropriate diet, and 
exercise in the open air, are the chief remedies. 

APHONIA, OR SUPPRESSION OF THE VOICE. 

Allusion is here made only to the affections of the voice 
of a nervous character, independently of inflammation. 
Changes of the voice of this kind are not uncommon. Some- 
times it becomes acute, or of a higher key, though feeble. 
The voice of a man is thus rendered feminine, or puerile. 
Sometimes the alteration is of an opposite character, the 
voice becoming low, or hoarse, or croaking, so that a child 
or a woman will speak like a man. In many instances it is 
entirely suppressed. No sound is formed above that of the 



554 FUNCTIONAL DERANGEMENTS. 

breath, and speech is in whispers. The attack may be 
sudden or gradual, and brief or of long and indefinite dura- 
tion. 

Causes. — These are numerous. Among the most frequent 
is the irregular distribution of nervous action consequent 
upon general debility, as after long-continued or exhausting 
diseases. The affection is often nothing but a form of 
hysteria. Sometimes it depends upon debility of the 
laryngeal muscles alone ; as where these have been over- 
strained by protracted and excessive efforts in speaking or 
singing. Occasionally an attack is brought on by a sudden 
and strong mental emotion, as of joy, anger, or fright. 
Quick changes from a warm to a very cold air have induced 
it. In some instances, it appears to depend on sympathy 
with intestinal irritation. 

Treatment. — When the disease depends on general debility, 
the obvious plan of cure is to restore strength by tonics, 
the cold bath, nourishing food, and exercise. When a mere 
form of hysteria, it is to be treated like spasm of the glottis 
from the same cause. If the brain is in fault, our remedies 
must be addressed to that organ, and must vary with the 
nature of the affection. Aphonia arising from temporary 
causes often disappears spontaneously. When produced by 
cold, it is cured by hot teas, or warm stimulating drinks, 
given so as to induce perspiration. Such measures are also 
obviously proper in all cases where the modification of the 
voice depends on debility of the laryngeal muscles. Under 
such circumstances, we may employ gargles of alum and 
other astringents, whether vegetable or mineral, stimulating 
inhalations, electricity, external irritation by means of 
sinapisms, blisters, croton oil, or a seton. 

As some of the following diseases consist in or are attended 
with inflammation, they might have been treated under the 
head of Particular Inflammations ; but as the disturbance 
they cause in the respiratory function constitutes their 
chief feature, we have chosen to group them under this 
head. 



COLD IN THE HEAD. 555 



CORYZA COLD IN THE HEAD. 

Symptoms. — The first sensations are usually those of 
dryness, fulness, and tickling, or other irritation in the 
nostrils, with sneezing. These are usually soon followed 
by a copious discharge of a thin, colorless, acrid fluid, 
which still further irritates the membrane, while it often 
inflames and even excoriates the skin about the nasal ori- 
fices, and on the upper lip. The nostrils are at this time 
not unfrequently either partially or wholly closed by the 
tumefaction of the inflamed membrane, which causes the 
voice to assume a nasal tone. There is often a considera- 
ble degree of dull pain or aching, with burning heat in the 
nasal passages ; and now and then severe stinging sensa- 
tions are experienced from the irritation of the acrid fluid. 
The eyes become red and watery, either from sympathy, or 
by the continuous extension of irritation along the lachry- 
mal passages ; and sometimes these passages appear to be 
closed, so as to occasion an overflow of the tears. A simi- 
lar extension of the disease to the frontal sinuses produces 
pain in the forehead. The maxillary sinuses are sometimes 
involved, with consequent pains in the face ; and hardness 
of hearing in a greater or less degree is not uncommon, 
from swelling and closure of the Eustachian tubes. Even 
the external parts occasionally participate in the inflamma- 
tion, and the nose and cheeks are swollen and tender. The 
sense of smell, and in a less degree that of taste, are al- 
most always blunted or lost. 

In many instances, the constitution does not seem to 
sympathize with the local affection; the pulse and skin 
remaining in their ordinary state, and the appetite unim- 
paired. Very frequently, however, febrile symptoms make 
their appearance, especially when the inflammation is of a 
high grade, and affects the whole of the nasal passages. 
Chilliness and pains in the limbs are followed by a hot skin, 
excited pulse, furred tongue, loss of appetite, and severe 
headache. The fever sometimes shows a tendency to exa- 
cerbations and remissions. 



556 FUNCTIONAL DERANGEMENTS. 

The complaint usually attains its height in three or four 
days, after which the symptoms begin to subside. 

Causes. — The most frequent exciting cause of coryza, is 
the partial application of cold, to the back of the head or 
neck, or to the feet ; and the effect is especially apt to be 
produced after perspiration from heat or exertion. Hence, 
the complaint is most common in winter. In some in- 
stances, it is probably induced by the breathing of a warm 
air after previous exposure to cold, in the same manner as 
chilblains. Some persons are much more liable to be 
affected in this way by cold than others. This greater 
susceptibility is frequently ascribable to a want of the 
habit of exposure ; but it is often also constitutional, and 
inexplicable. Individuals are occasionally met with who 
are liable to attacks of the complaint periodically, at a cer- 
tain date, once a year, without reference to the state of the 
weather at the time. Others are attacked at the com- 
mencement of winter, and are scarcely entirely free from 
the complaint until warm weather returns. Coryza is also 
frequently epidemic, being a very general attendant upon 
the influenza. It is very common at the beginning of the 
measles, and sometimes accompanies other exanthemata in 
their earlier stages, especially small-pox and scarlet fever. 

Treatment. — Most cases of this disease are so mild as not 
to require treatment, and scarcely to interrupt the avoca- 
tions or pleasures of the patient. When there is no fever, 
it is usually sufficient to direct a dose of sulphate of mag- 
nesia, abstinence from animal food, and the avoidance of 
exposure to cold or wet. Should the patient be under the 
necessity of leaving his house, he should clothe himself 
warmly, take care especially to keep his feet dry, and pro- 
tect his nostrils by a handkerchief against the cold. Should 
the symptoms be more severe, and fever present, the treat- 
ment, in addition to the above measures, may consist of hot 
pediluvia, made more stimulating by the addition of com- 
mon salt or mustard, and the use of , refrigerant diaphore- 
tics, as the citrate of potassa, acetate of ammonia, nitre, 
and tartar emetic, variously combined to suit the circum- 



CHRONIC INFLAMMATION OF THE NOSTRILS. 557 

stances of the case. The patient should be confined to bed, 
and should lie with his head raised by pillows. When 
there is much headache, with a full, strong pulse, and the 
symptoms have not yielded to the above treatment, with 
additional purgation by one of the neutral salts, a little 
blood may be taken by the lancet from the arm, or, in case 
of inflammation of the frontal or maxillary sinus, by 
leeches from the forehead or cheek, or from within the 
nostrils. 

Various measures have been recommended to relieve the 
local symptoms, which are often very distressing. Breath- 
ing the chloroform liniment, as recommended in catarrh, 
usually affords great relief; and, if done early, will often 
subdue the irritation and cut off the disease at once. 

When an individual is subject to the complaint in its 
severer forms, and especially when previous experience 
suggests that it is likely to be the precursor of a protracted 
disease of the chest, it is important to be able to set the 
attack aside at its very commencement. This can with 
great certainty be done by the use of the liniment, and 
taking a full dose of Dover's powder before going to bed — 
five or even ten grains may be taken in some sweating tea. 
The patient will often awake in the morning quite free from 
the disease. 

It is very desirable to be in possession of a prophylactic 
against this troublesome affection. I know of none so 
effectual as the daily habit of washing the head and back 
of the neck in very cold water ; or, where wet feet are the 
ordinary cause, to dip them in ice-cold water every morn- 
ing. It is best to begin with this plan in warm weather, 
and persevere through the winter. The cold shower-bath 
is also recommended. 

OZ^ENA, OR CHRONIC INFLAMMATION OF THE NOSTRILS. 

Chronic inflammation of the nostrils is sometimes dry, 
being attended with little if any increase, or even with a 
deficiency of the usual amount of secretion. There is a 
feeling of uneasiness, heat, and stiffness in the nostrils, 
which are often closed, on one or both sides, from the thick- 



558 FUNCTIONAL DERANGEMENTS. 

ening of the membrane, so as to impede the passage of air ; 
and this is generally the greatest inconvenience experi- 
enced. When it affects the posterior nares, there is a fre- 
quent disposition to clear them out by sudden and forcible 
inspirations of air through the nostrils. 

In other cases, there is a copious secretion of a whitish, 
somewhat opaque mucus, or of a yellowish muco-purulent 
matter, with little uneasiness or discomfort other than that 
which arises from the constant necessity of blowing the 
nose. 

Again, the discharge is occasionally quite purulent, and 
of a yellowish or greenish color, or it is sanious and fre- 
quently tinged with blood ; and in both cases has an odor 
generally more or less disagreeable, and sometimes intolera- 
bly offensive. In this form, the disease is called ozcena, and 
is one of the most obstinate and disagreeable affections. 
In some instances, the breath of the patient is so revolt- 
ingly offensive, as almost to isolate him from society, and 
to render him an object of disgust even to himself. There 
is reason to believe that this affection sometimes occurs 
without any violation of the integrity of the mucous mem- 
brane ; but more frequently it is associated with ulceration, 
and sometimes with caries of the bones. In the latter case, 
pieces of bone are sometimes discharged along with the pus 
or sanies. Large solid flakes of excessively offensive mat- 
ter are occasionally discharged along with blood. The 
sense of smell in these cases is almost always much im- 
paired, if not entirely lost. 

Whatever may be the form of chronic inflammation of 
the nostrils, it often runs on for months or years, sometimes 
even for many years, and, in the form of ozsena, is, in cer- 
tain old cases, quite incurable. 

Causes. — In many instances, the chronic disease results 
from a continuation or frequent repetition of the acute. It 
is often also original. The cause is generally obscure, but 
I think is nearly always connected with a scrofulous taint 
of the system. 

Treatment. — In simple chronic inflammation, cures may 
very often be effected by the injection into the nostrils of 



LARYNGITIS. 559 

solutions of acetate of lead, sulphate of zinc, sulphate of 
copper, or nitrate of silver. I have usually preferred sul- 
phate of zinc, beginning with two grains to the fluidounce 
of water, and rapidly increasing, as the nostrils are found 
to bear the impression, to ten, fifteen, or even twenty grains 
to the fluidounce. The injection should be repeated daily 
or twice a day, and continued perseveringly for months if 
necessary. It is important that, by a proper direction of 
the instrument, and position of the head, the fluid should 
be made to reach the seat of disease, whether this occupy the 
whole of the membrane, or, what is much more frequent, 
some comparatively small portion of it, in the nasal 
passages or the sinuses. Sometimes the part can be 
reached by a camel's hair pencil, in which case this is the 
best means of applying the solution, as the sound portions 
of the nostrils may thus be avoided, and a stronger solu- 
tion may be employed. When the discharge is offensive, 
solutions of creosote, or of chloride of soda, potassa, or 
lime, will do much towards correcting the fetor, and may 
prove useful as alteratives to the mucous surface. Some- 
times advantage will result from the mere washing out of 
the retained mucus, two or three times daily, by injections 
of warm water. When an ulcer exists and is within reach, 
it may be treated by the direct application of solid nitrate 
of silver, or by a saturated solution applied by means of a 
camel's hair pencil. The general treatment should be the 
same as directed for scrofula, which see. 

LARYNGITIS, OR INFLAMMATION OF THE LARYNX. 

The larynx, though most commonly involved with inflam- 
mation of other parts of the respiratory passages, is some- 
times exclusively, and often chiefly affected. Inflammation 
of the larynx is not uncommon, and is in general very 
manageable ; though, in a few instances, when very intense, 
or attended with an unusual degree of serous effusion into 
the sub-mucous tissue, it becomes very alarming and even 
fatal. Its great danger, under these circumstances, is owing 
to the narrowness of the passage through the chink of the 
glottis, which is closed by the swollen state of its walls, 
36 



560 FUNCTIONAL DERANGEMENTS. 

aided probably by spasm of the muscles/ against the admis 
sion of air; so that the patient dies of true asphyxia. 
There is no other portion of the respiratory passages in 
which an equal extent of inflammation is capable of pro- 
ducing the same fatal results. As in most other inflamma- 
tions, the disease may be acute or chronic. 

ACUTE LARYNGITIS. 

When originating in the larynx, and not the result of 
some direct violence, this form of laryngitis usually com- 
mences with a distinct chill, or with chilliness alternating 
with flashes of heat, which is followed by fever, with a full, 
strong pulse, a hot skin, and flushed face. At the same 
time, some soreness of the throat is felt, the voice is hoarse, 
and a sense of tightness, stricture, or pressure is experi- 
enced, as if there were some mechanical impediment in the 
larynx. To remove this the patient coughs, but brings up 
nothing, or only a little clear, viscid mucus. The cough is 
painful, and its sound is harsh and stridulous. Great diffi- 
culty of breathing soon comes on. The inspiration is pro- 
longed, wheezing, whistling, or otherwise sonorous, and 
requires a considerable effort on the part of the patient. 
The expiration is performed more easily and silently, as the 
swollen membrane of the glottis acts like a closing valve 
against the entrance of the air, but opens readily for its 
exit. The epiglottis may sometimes be seen of a bright or 
deep red color, erect, and much swollen, so as to be unable 
to descend and close the glottis during deglutition. The 
external parts about the larynx are also often much swollen, 
though not invariably so. Deglutition is difficult, partly 
from inflammation of the fauces, but chiefly in consequence 
of the swollen state of the epiglottis, which prevents it from 
closing accurately over the orifice of the windpipe, and thus 
allows the substances swallowed to enter the larynx, where 
they excite intense irritation, and give rise to vehement 
paroxysms of coughing, with the most distressing dyspnoea. 

Should the case now continue to advance, all the symp- 
toms are aggravated. The voice becomes wheezing or 
whispering, or is quite extinguished; the cough, of which 



ACUTE LARYNGITIS. 561 

the sound is scarcely above the breath, is agitating, often 
convulsive, and very painful; inspiration is exceedingly 
difficult, and is accomplished only after violent efforts, with 
great distress and anxiety, and a feeling as of impending 
suffocation. The patient is in general extremely restless, 
sometimes starting up suddenly in bed, walking about the 
chamber, putting his hands to his throat, showing the great- 
est eagerness for fresh air, and expressing in his countenance 
an almost fearful anxiety, apprehension, and distress. He 
is unable to sleep longer than a few minutes at a time, being 
constantly roused by the necessity for voluntary effort to 
get breath. The blood now begins to exhibit signs of defi- 
cient aeration, which rapidly increase in intensity. The 
lips have a bluish or purplish color, the face becomes of a 
livid paleness, and a dark circle forms about the eyes, which 
are sometimes protruded and watery. The surface is cool, 
and the pulse frequent, irregular, threadlike, and very feeble. 
In the midst, however, of this exhaustion, the patient makes 
the most violent efforts ; his shoulders rise ; his whole chest 
heaves ; his countenance assumes a staring and ghastly ex- 
pression ; his skin is bathed in a cold sweat ; and he sinks 
at last into a drowsy or comatose state, often preceded by 
delirium, and speedily followed by death. 

Many remedies are recommended by authors for this dis- 
ease. Only one has been found necessary in our hands, 
and that is the chloroform liniment. In mild cases it is only 
necessary to bathe the throat with it, and then apply flannel 
around the neck — a sock fits the parts best, the heel being 
adjusted to the front ; but, in severe cases, the sock should 
be saturated with the liniment, and let remain until the sur- 
face is thoroughly blistered, which will usually be accom- 
plished in from three to ten minutes. Then dress the 
blister with a mush poultice, well greased. The patient 
should keep within doors, and drink only warm teas for a 
day or two. This treatment, I think, will always supersede 
the necessity of tracheotomy, or opening the windpipe, which 
is now the fashionable remedy in England, and strongly 
recommended by some American writers, and which would 
be a justifiable measure, if no less dangerous means would 



562 FUNCTIONAL DERANGEMENTS. 

succeed in saving the patient, for the operation does not 
always kill. 

CYNANCHE TRACHEALIS CROUP. 

Cynanche trachealis consists of inflammation of the tra- 
chea, often of the trachea and larynx, ending, in some cases, 
in the exudation of false membranes upon the affected sur- 
face. 

It is a disease of early life ; most cases of it occur during 
the second year of childhood. It is often complicated with 
bronchitis or pneumonia. 

Symptoms. — In the commencement they are those of a 
cold ; slight fever, cough, hoarseness, drowsiness, suffusion 
of the eyes, and running at the nose. In a day or two the 
peculiar signs of croup begin to show themselves, commenc- 
ing with an alteration in the character of the cough, which 
becomes attended with a peculiar ringing sound, rendering 
it " brassy ;" this cough being also followed, in a few hours, 
by a remarkable change in the respiration. The act of in- 
spiration becomes prolonged, and attended with a character- 
istic crowing or piping noise, readily recognized when once 
it has been heard. If now the fauces be examined, the 
tonsils will be found enlarged, and of a red color, but less 
intense than in tonsillitis ; the uvula also is sometimes slight- 
ly swollen. As the disease advances, the fever increases, 
the breathing becomes more hurried and impeded, the cough 
more frequent ; the pulse becomes weak and irregular, there 
is great thirst, and the child is very irritable and restless, 
and, with features expressive of alarm and distress, he 
grasps at his neck, or thrusts his fingers into his mouth, as 
if to remove the cause of his sufferings. Exacerbations 
always take place at night, with remissions toward the 
morning. Should there now be a tendency toward a resto- 
ration to health, the cough will lose its peculiar clang, and 
become moist, whilst the crowing inspirations will almost 
cease. On the other hand, when the disease is about to end 
fatally, the drowsiness soon becomes extreme, though the 
sleep is uneasy ; the child starts and wakes in terror ; the 
breathing becomes gasping and interrupted ; the skin gets 



CYNANCHE TRACHEALIS CROUP. 563 

cold and covered with clammy sweats ; and the child often 
dies directly after an inspiration, or coma and convulsions 
ensue, and close the scene. 

Sometimes this disease runs a very rapid course, though 
usually its duration ranges from four to ten days. 

Diagnosis. — The history of the attack, the hoarseness or 
loss of voice, the dry, ringing cough, the croupal inspirations, 
and the fever, distinguish this disease from every other. It 
can indeed only be confounded with true laryngitis ; but 
this latter affection occurs in adults, very rarely in children, 
except as associated with croup ; it causes a fixed, burning 
pain in the larynx, increased by any examination ; it does 
not give rise to the exudation of false membranes ; and, if 
prolonged, it ends in suppuration or ulceration. The diag- 
nosis between croup and laryngismus stridulus, or crowing 
disease, is simple ; for in the latter there is an absence of 
fever and of the peculiar cough, while during the intermis- 
sions the patient is apparently well. 

Treatment. — In no disease, perhaps, is it more necessary 
to be prompt and cautious. Bleeding, tartar emetic, and 
mercury, are the measures on which we are usually taught 
to rely ; but I cannot help thinking that this treatment is 
unsound, since we find that, however early and perseveringly 
applied, yet the disorder proves fatal. Would it not be 
better, then, to try the effects of a different and perhaps 
milder plan ? For the reasons already stated, I should not 
advise the abstraction of blood, nor would I recommend 
large doses of tartar emetic or mercury. When the disease 
is seen early, the continuous application of hot fomentations 
to the throat will do great good; but if much benefit is not 
quickly apparent, emetics may also be administered; while, 
when the heat of the body is above the normal standard, a 
warm bath will lessen it. 

Supposing that the disease advances, notwithstanding 
these measures, I resort to the use of the iodide of potas- 
sium, combined with assafoetida, from which I think I have 
seen great benefit. 

In order to prevent the formation of false membranes, it 
is said that mercurial inunction should be had recourse to 



564 FUNCTIONAL DERANGEMENTS. 

from the commencement of the severe symptoms, half a 
drachm, or even a drachm, of the unguentum hydrargyri 
being gently rubbed in every four or six hours. The prac- 
titioner must use his own judgment as to the employment 
of this agent. No harm can arise from calomel given at the 
onset as a purgative, in doses of two, three, or four grains. 
In the latter stages of the disease, it will be necessary to 
support the powers of life by beef-tea ; and wine, or a few 
drops of the aromatic spirits of ammonia, or of brandy, with 
water, should be frequently repeated. — Tanner. 

My method of managing croup is as follows : In the 
forming stage, bathing the feet and legs in hot mustard-water, 
rubbing the throat with chloroform liniment, and a few tea- 
spoonfuls of Cox's hive-syrup, or of equal parts of wine of 
ipecac, and paregoric, will usually be sufficient. But if the 
disease progresses, I give emetic doses of calomel and ipecac, 
and, as there is in this disease a great insensibility to the 
influence of medicine, the dose must be large : ten grains 
of each are not too much. If vomiting does not take place 
in the course of half an hour, I repeat the ipecac, or give 
mustard-water if the case seems to be urgent. After the 
child has vomited freely, I give from two to three grains of 
Dover's powder, or one or two teaspoonfuls of paregoric, 
and apply to the throat and breast a towel wrung out of 
cold water, with the liniment freely sprinkled on the side 
applied to the surface, and cover it with a dry flannel, still 
keeping the feet immersed in the hot mustard-water, or 
enveloped in cloths saturated with it, and kept hot by hot 
rocks or bricks. After relief has been obtained by these 
means, a dose of castor oil with a few drops of turpentine 
is given, and the child suffered to remain quiet, and all noise 
or disturbance suppressed which might prevent it from 
sleeping. It will usually awake quite relieved, and nothing 
more is necessary to be done than to give a little hive-syrup 
occasionally, and keep it within doors for a few days, except 
in very fine weather. 



FUNCTIONAL DISEASES OF THE HEART. 565 



CHAPTER III. 

FUNCTIONAL DERANGEMENTS CONNECTED WITH THE CIRCULATORY 

SYSTEM. 



FUNCTIONAL OR NERVOUS DISEASES OF THE HEART. 

These are, on several accounts, highly deserving of the 
notice of the physician. They are very frequent ; are in 
themselves often the source of much inconvenience, distress, 
and even danger ; and occasionally terminate, when of long 
duration, in fatal organic affections of the heart. Besides 
imitating, as they often do, very closely these affections, they 
are apt to occasion much anxious apprehension on the part 
of the patient, lest he may be laboring under incurable dis- 
ease. In order, therefore, to be able to give all proper con- 
solatory assurances, and with the view also of obtaining 
just indications of treatment, which often differs greatly in 
the two orders of diseases, it is of great importance to form 
a correct diagnosis. This is not difficult in decided cases ; 
but there are some in which a sure decision is almost impos- 
sible, and the greatest skill must be satisfied with probable 
conjecture. The best plan of diagnosis is probably, first, 
to determine what circumstances are incompatible with the 
idea of mere functional disorder, and, secondly, what are 
compatible only with that idea. We shall thus, at least, 
separate the certain from the doubtful, and it will be found 
in practice that only a comparatively small number of cases 
will be left uncertain. 

In nervous or purely functional diseases, the characteristic 
symptoms are scarcely ever, perhaps never, constant during 



566 FUNCTIONAL DERANGEMENTS. 

a great length of time. In the organic, though there are 
some cases in which the signs are not always obvious, and 
many in which they are much more obvious at one time 
than another, yet in the great majority of them, as the lesion 
is invariably present, so also are its evidences, which may 
be discovered if carefully sought for. When, therefore, the 
peculiar signs of cardiac disorder are discoverable at all 
times and under all circumstances, by night and by day, in 
sleeping and waking, during rest and exertion, not only for 
days, but for weeks, months, or years together, the inference 
is unavoidable that they are something more than functional. 

In cases attended with continued or permanent secondary 
affections, resulting from the strong sanguineous determina- 
tion and venous congestion of cardiac disease, such as bloated 
features, purple lips, bleedings from the nose, apoplexy, 
pulmonary hemorrhage and oedema, general dropsy, etc., the 
probabilities are altogether in favor of the existence of 
organic derangement. 

When the symptoms of cardiac disease are ameliorated 
by vigorous exercise, as not unfrequently happens, we may 
be very certain that the complaint is not organic. It does 
not follow that every case of functional derangement is 
directly relieved by this means. On the contrary, when 
such derangement accompanies anaemia, it is often greatly 
aggravated by bodily motion. We only infer that it must 
be functional whenever it is susceptible of alleviation in this 
way. 

Moreover, when the cardiac symptoms can be traced to 
some particular cause, appearing when that is in action, and 
disappearing when it ceases to act, as, for example, when 
they accompany the abuse of narcotic or stimulating sub- 
stances, and vanish when these are used no longer, they 
must be considered as strictly functional. 

Cases which do not fall into one of the above categories 
must be judged of according to the weight of probabilities. 
The conditions which should incline the scale towards organic 
disease have been mentioned under the individual complaints 
belonging to that division. Those of a contrary tendency 
will be alluded to under the following heads. 




ARTERIAL SYSTEM. 



PALPITATION. 567 

Functional disease of the heart may evince itself by 
alteration either in the movements or the sensations of the 
organ, and in either case may have the character of irrita- 
tion or of depression. Deranged movement may be included 
under the two divisions of palpitation, in which the heart is 
under excitement or irritation, and syncope, in which it acts 
feebly or ceases to act. Neuralgia of the heart, or angina 
pectoris, includes all the cases of mere functional affection 
of a painful character ; and this may be associated with 
elevation or depression of the vital power of the organ. 

PALPITATION. 

This term is used to signify inordinate pulsations of the 
heart, sensible to the patient himself, or readily perceived 
by the observer. It varies in degree from a scarcely per- 
ceptible movement, to one so tumultuous and violent that it 
visibly agitates the whole chest, and occasions great distress. 
The pulsations may be increased in frequency or in force, 
or both. They are sometimes regular, but more frequently 
irregular, intermittent, and fluttering ; and the pulse partakes 
of the same qualities. 

The attack often comes on under some mental or physical 
excitement, but often also when the patient is at rest, and 
not unfrequently in the night, awakening him perhaps from 
his first sleep. When violent, it may occasion much dis- 
tress. The heart feels as if bounding upward into the 
throat; a sense of anxiety or oppression is experienced in 
the precordial region, with hurried and difficult respiration, 
so that the patient is frequently unable to lie down ; ringing 
in the ears ; vertigo ; faintness, and even syncope. The 
duration of a paroxysm is quite uncertain, sometimes not 
exceeding a few minutes, sometimes lasting for days without 
absolute intermission, though varying much in violence 
during that time. Most commonly, it terminates within 
thirty minutes or an hour, recurring afterwards quite irregu- 
larly, sometimes daily or several times a day, and sometimes 
not until after a long interval. 

Causes. — Strictly speaking, palpitation is rather the result 
of disease than a disease itself; and the real morbid condi- 



568 FUNCTIONAL DERANGEMENTS. 

tion upon which it depends, leaving organic affections out of 
view, is either deranged innervation of the heart, or an un- 
healthy state of the blood, which may be too rich and 
abundant, constituting plethora, or too watery or otherwise 
depraved, as in anaemia, scurvy, etc. The true causes, 
therefore, are such as produce either of these conditions. 

The age at which palpitation is most frequent is that 
which intervenes between puberty and perfect maturity. 
Females are more apt to be affected with it than males. 

Particular acts of palpitation, in one predisposed to it, 
may be induced by any thing of an exciting nature, whether 
intellectual, emotional, or purely physical. 

Treatment. — In the treatment of functional palpitation, 
the most important point is to remove the cause. The use 
of all nervous stimulants and narcotics, including tea, 
coffee, and tobacco, should be suspended or abandoned; 
injurious habits of indulgence should be overcome; the 
most watchful guard should be kept by the patient over 
his emotions, and, while the mind is moderately occupied, 
all over-exertion should be avoided ; a due amount of sleep 
and of bodily exercise should be obtained; and whenever 
there may be reason to suspect the agency of some other 
disease, our efforts should be especially directed towards 
its removal. As the anxieties and fears of the patient tend 
strongly to aggravate and perpetuate the complaint, we 
should endeavor to cheer him by every assurance of a favor- 
able termination which the circumstances of the case may 
justify. 

In the paroxysms, relief will often be afforded by the 
nervous stimulants, as assafcetida, musk, valerian, the 
ammoniacal and ethereal preparations, camphor, strong tea, 
etc. Among the best of these are Hoffmann's anodyne, 
and the aromatic spirit of ammonia, which may be given 
separately or mixed. The preparations of opium or hyos- 
cyamus, or one of the other narcotics, may sometimes be 
usefully conjoined with the antispasmodics. From one to 
three teaspoonfuls of paregoric will often afford relief. 
Aromatics, combined with antacids, are sometimes useful by 
expelling flatus and correcting acid, which are occasionally 



FAINTING. 569 

the exciting causes. . When an overloaded stomach is sus- 
pected as the exciting cause, a moderate emetic dose of 
ipecacuanha may not be amiss. Should a gouty or rheu- 
matic diathesis exist, and stimulants be indicated, a very 
good preparation is the ammoniated tincture of guaiac. 
These remedies should be seconded by measures calculated 
to invigorate the system generally, such as exercise in the 
open air, which should be of the passive kind in the anemic 
cases, the occasional or daily use of the shower-bath, fric- 
tions to the surface, and a diet of nutritious and easily- 
digested food. 

SYNCOPE FAINTING. 

Syncope is a diminution or temporary cessation of the 
action of the heart, with loss of consciousness, and a sus- 
pension more or less complete of respiration. It sometimes 
comes on suddenly without premonition ; but is much more 
frequently preceded by signs which indicate its approach, 
such as a feeling of nausea or of sinking in the epigastrium, 
clouded or otherwise disordered vision, mental confusion, 
pallid and shrinking features, and a rapidly failing pulse. 
In general the preliminary sensations are disagreeable, some- 
times exceedingly so ; but occasionally they are grateful to 
the patient. In complete syncope, the features are collapsed 
and of a ghastly paleness, the surface cool, the pulse quite 
absent at the wrist, respiration suspended, and conscious- 
ness entirely wanting. Sometimes involuntary discharges 
take place from the bowels and bladder. The heart, how- 
ever, seldom quite ceases to beat. The ear applied to the 
chest will generally detect the first sound, greatly weakened, 
but not the second. This is an important sign in diagnosis, 
as, when observed, it indicates always some hope of saving 
life. After a short time, the patient again draws his 
breath, color gradually reappears in the lips and cheeks, the 
pulse may be felt at the wrist, consciousness returns, and 
very soon the recovery is complete. In some instances, it 
is attended with feelings of much distress. 

Causes. — These are such as act either directly upon the 
heart, or indirectly through the nervous system. Of the 



570 FUNCTIONAL DERANGEMENTS. 

first set of causes there are comparatively few, if we except 
the organic diseases of the heart, which not unfrequently 
produce syncope, and occasionally terminate in that way. 
Among the direct causes, however, may be ranked sudden 
attacks of neuralgia of the heart, translated rheumatism or 
gout, certain poisons which operate immediately upon the 
circulation, especially the antimonials, and a state of depres- 
sion following excessive excitement of the organ, the seda- 
tive influence of the warm bath, etc. 

The causes- of syncope which act on the heart through 
the nervous system are very numerous. Whatever opinion 
we may entertain as to the inherent and independent irrita- 
bility of. the heart, this much is quite certain, that it is 
under the controlling influence of the nervous system, and 
often ceases to act when that influence is suspended or per- 
verted. Hence, violent shocks on the nervous system, 
which paralyze it for an instant, are frequent causes of 
syncope. Hence the effects of sudden intelligence, whether 
exciting or depressing ; of certain offensive or fearful sights, 
as a public execution, or a painful surgical operation; of 
sudden and excruciating pain, as sometimes in spasm of the 
stomach or bowels ; and of violent injuries to the frame, 
whether from accident, or the knife of the surgeon. Much 
milder impressions on the nervous system often have the 
same effect upon the heart; such, for example, as result 
from certain rich and oppressive odors, the feeling of nausea 
connected with gastric disorder, the sensations excited in 
pregnancy by the movements of the foetus, and excessive 
hunger, or rather want of food. The presence of indiges- 
tible matters in the stomach sometimes has a powerful 
effect of this kind. Under the head of causes acting through 
the nervous system may also be placed certain powerful 
poisons, as digitalis, tobacco, and hydrocyanic acid. 

Deficiency or loss of blood is well known to be a frequent 
cause of syncope. 

Diagnosis. — The only conditions from which syncope may 
not be readily distinguished are apnoea [suspended breathing] 
and death. In the former, there is the same absence of 
consciousness, respiration, and pulse at the wrist ; but the 



FAINTING. 571 

aspect of the body is usually sufficient to distinguish the 
cases. In apnoea there are signs of general venous con- 
gestion, such as purple lips, swollen features, and a more or 
less dingy or livid hue of the surface ; while in syncope the 
countenance is pallid and collapsed, and the skin apparently 
bloodless. The cause, if known, will also frequently serve 
to aid in the diagnosis. If it be such as acts primarily on 
the lungs, it produces apnoea; if upon the heart, syncope. 

Treatment. — The first thing to be done in syncope, 
threatened or existing, is always to place the patient in a 
horizontal position, with the head at least as low, if not 
lower than the rest of the body. By this simple measure, 
employed when the premonitory symptoms are first felt, an 
attack may very frequently be averted ; and it is also one 
of the most effectual means of restoration after the attack ; 
sometimes, indeed, absolutely essential to recovery. Hence 
the importance of distinguishing such cases from those 
dependent upon congestion of the brain. An individual 
subject to syncope should at once lie down when he feels 
an attack approaching. Sometimes, as in cases of excessive 
hemorrhage, it is necessary to maintain the horizontal posi- 
tion steadily for a considerable time ; until, in fact, the 
blood-vessels are again supplied by nutrition. At the same 
time that this measure is employed, all pressure from tight 
dresses, corsets, cravats, etc., should be carefully removed 
from the chest, neck, and abdomen, and the patient should 
be surrounded with pure fresh air. 

Means should also be employed to rouse the nervous 
system. For this purpose, spirits of hartshorn, strong 
vinegar, or other very pungent volatile substance, may be 
so applied that the vapors may enter the nostrils ; but care 
must be taken not to carry the remedy too far, lest it pro- 
duce severe inflammation of the part. The smoke of burnt 
feathers has been employed for the same purpose. Sprink- 
ling cold water upon the face is also useful, by the shock 
which it produces on the nerves. Slapping the palms of 
the hands, and making a shrill sound in the ears of the 
patient, are vulgar remedies which are not without effect. 
If the patient can swallow, he may take a draught of cold 



572 FUNCTIONAL DERANGEMENTS. 

water, which seems to act upon the mucous surface in the 
same manner as on the skin, by exciting a sensation that 
leads to reaction. Diffusible stimulants should also be 
administered, especially the ethereal and ammoniacal prepa- 
rations ; and, as in palpitations, the most convenient forms 
are Hoffmann's anodyne or compound spirit of sulphuric 
ether, and aromatic spirit of ammonia. In cases of great 
debility, brandy may be used. Should the patient be un- 
able to swallow, and the syncope not speedily yield to the 
measures above recommended, stimulants, such as oil of 
turpentine, brandy, and carbonate of ammonia, properly 
diluted, should be injected into the rectum. 

Remedies must also be applied to the surface. The body 
should be kept warm, but not overheated ; frictions should 
be employed with a fleshbrush or coarse flannel ; and rube- 
facients should be applied along the spine and to the ex- 
tremities, care being always taken not to permit them to 
remain so long, or to be used with such a degree of inten- 
sity, as to endanger much inflammation on the occurrence 
of reaction. A most powerful means of producing excite- 
ment, is a bundle of small switches applied briskly to the 
spine. 

When the syncope has proceeded from large draughts of 
cold water taken into the stomach in hot weather, the 
patient, if able to swallow, should take full doses of lauda- 
num, with ether, solution of ammonia, hot brandy toddy, or 
even water alone, made as hot as it can well be borne. The 
other remedies above mentioned may be used at the same 
time, and especially a sinapism over the epigastrium. 

When an overloaded stomach, or some acrid or indiges- 
tible matter in the stomach, is the cause of the affection, it 
would be proper to administer an emetic of powdered 
mustard with warm water or warm chamomile tea, which 
may be aided if necessary by a little ipecacuanha. 

ANGINA PECTORIS, OR NEURALGIA OF THE HEART. 

Neuralgia of the heart and angina pectoris are consid- 
ered by some as different diseases ; but it is impossible to 
point out any important distinction between them. Though 



NEURALGIA OF THE HEART. 573 

angina has frequently been found in connection with organic 
disease of the heart, yet frequently no such affection has been 
detected upon examination after death ; so that it must be 
considered as essentially nervous. Angina is, therefore, a 
painful nervous affection, and this is the very definition of 
neuralgia. 

Symptoms. — The disease is characterized by severe pain 
in the left side, occurring at irregular intervals, with free- 
dom from pain between the attacks. In the paroxysm, the 
pain generally shoots through the chest towards the back, 
and into the left shoulder, and not unfrequently extends 
down the arm, where it is attended with a feeling of numb- 
ness. This combined sensation is sometimes felt as far as 
the fingers, proceeding downward from the elbow, along the 
course of the ulnar nerve. Sometimes also the pain 
spreads to the anterior part of the chest, ascends up the 
left side of the neck, or descends to the left leg, and cases 
are mentioned in which it has even extended to the right 
side of the body. There is occasionally exquisite tender- 
ness of the left mamma in the female, and pain upon pres- 
sure in different parts of the chest, both anteriorly and 
posteriorly, in both sexes. There is every grade of vio- 
lence in the sensation, from a dull aching numbness, up to 
the most acute and excruciating pain. Along with the 
pain, there is often a sense of tightness or oppression in the 
chest, with dyspnoea, inability to lie down, and sometimes 
violent palpitations ; and the patient not unfrequently has 
the feeling that he cannot live unless speedily relieved. 
Though the breathing is apparently much oppressed and 
difficult, yet the lungs can generally be fully expanded by 
a voluntary effort. The pulse is usually small, irregular, 
and feeble, but sometimes strong and voluminous. Occa- 
sionally the paroxysm ends in convulsions or syncope. 
There is often much flatulence of stomach, and the urine 
during the paroxysm is pale and limpid. 

The paroxysm varies in length from a very few minutes 
to half an hour, or even an hour, and sometimes, though 
rarely, exceeds the last-mentioned period. The patient is 
sometimes free from pain, and in apparent health, during 



574 FUNCTIONAL DERANGEMENTS. 

the intervals ; but more frequently he suffers with occa- 
sional uneasiness in the region of the heart, which evinces 
signs of some form of organic disease of that organ. 

The first attack, which is in most cases comparatively 
mild, is usually experienced upon the occasion of some ex- 
traordinary exertion, such as ascending a height, especially 
in the face of a cold wind. The patient is suddenly seized 
with pain, and immediately stops, feeling that it is utterly 
impossible for him to advance, and as if he should die were 
he to make the effort. After a few minutes, however, the 
pain subsides, and he is enabled to proceed. The attack is 
afterwards repeated, but at a very uncertain interval — after 
one or more weeks, for example, or months, or a year ; but 
the interval generally diminishes with the continuance of 
the complaint ; so that at length the patient becomes liable 
to a paroxysm upon the slightest excitement, and even 
without any apparent exciting cause. 

But there are many cases much less severe : the pain 
may not be less acute ; but it is not so extensive, recurs 
quite irregularly both as to degree and time, and may dis- 
appear for a very long period, or never return. There are, 
indeed, fugitive pains in the heart as in other organs, de- 
pending on various causes of nervous derangement, and 
quite trivial in their nature, which it is necessary, if they 
are classified at all, to place along with neuralgia. The 
same may be said of that sort of uneasy feeling about the 
heart, extending often to the shoulder and arm, which con- 
sists rather in a sense of stricture, weight, or aching numb- 
ness, than of positive pain, and which is not uncommon in 
nervous and dyspeptic patients of a gouty or rheumatic 
constitution. 

Instances of cardiac neuralgia have been observed, in 
which the paroxysm returned at certain fixed periods, with 
imperfect freedom from pain in the interval. Such cases 
are strictly analogous to the intermittent or periodical neu- 
ralgia, which frequently occurs in other parts of the body. 

It is asserted that angina pectoris has sometimes disap- 
peared upon the breaking out of certain eruptions upon the 
skin. 



NEURALGIA OF THE HEART. 575 

Like neuralgia in other situations, that of the heart may 
be associated with, and possibly in some measure dependent 
upon, general debility, nervous derangement of the system 
at large, and the chlorotic or anemic condition of the circu- 
lation. It is one of the forms in which hysteria shoAvs 
itself, and is apparently, in some instances, connected with 
tenderness of the spine. It occasionally alternates with 
neuralgia elsewhere, especially in gouty or rheumatic indi- 
viduals. It has sometimes appeared to originate in con- 
tinued and deep distress of mind. There is good reason to 
believe that it is sometimes a result of miasmatic influence. 
Occasionally, it is associated with general plethora, which 
may possibly serve sometimes as the exciting cause. Dys- 
pepsia and disease of the liver often occasion neuralgic sen- 
sations in the heart. The complaint is apt to come on 
when the stomach is overloaded with food, distended with 
flatus, 'or irritated by acid or indigestible matters. 

Treatment. — The remedial measures are, first, those 
adapted to the paroxysm; and, secondly, those which are 
to be used in the interval. 

1. During the paroxysm, the patient should be kept at 
rest; and to relieve the pain, anodyne and antispasmodic 
medicines should be given freely ; and none are so effica- 
cious as the preparations of opium, as laudanum, the black 
drop, and the salts of morphia, of some one of which a 
large dose should be given at once, and repeated if the first 
should not prove successful. Should the pulse be feeble, 
and the skin cool, the ammoniacal or ethereal preparations, 
musk, assafoetida, or camphor, should be prescribed, sepa- 
rately or variously combined ; and, in such cases, with a 
gouty or rheumatic taint, ammoniated tincture of guaiac 
may be added. Should evidences of acid or flatus in the 
stomach exist, carbonate of ammonia is well calculated to 
meet the indications ; or various mixtures of aromatics and 
antacids may be administered. When there is reason to 
suspect an overloaded stomach as the cause, vomiting 
should be produced by ipecacuanha, aided by warm water, 
infusion of chamomile, or mustard water. 

Hot pediluvia, rendered more stimulating by mustard or 
37 



576 FUNCTIONAL DERANGEMENTS. 

cayenne pepper, should be employed simultaneously with 
the internal remedies. The chloroform liniment, applied to 
the chest and along the spine, will be found to be of great 
advantage. 

2. In the interval, the exciting cause should be carefully 
avoided, and the patient should therefore sedulously culti- 
vate calmness of mind and perfect equanimity, while he 
avoids all vigorous muscular effort. At the same time, the 
general health should be carefully attended to, as the best 
safeguard against the attacks of the disease. Dyspepsia 
should be corrected with especial care, along with its con- 
comitants, acidity, flatulence, and constipation. {See Dys- 
pepsia.) In employing exercise in reference to the state of 
the general health, the passive kinds, as on horseback, or in 
a carriage, should be decidedly preferred to the active. 
Any existing morbid tendency which may have predisposed 
to the disease, or excited it, should receive due attention. 
Hence, rheumatism, anaemia, or hysteria, if present, should 
be treated with appropriate remedies ; but when rheuma- 
tism is seated in a safe and convenient spot, caution should 
be observed not to remove it by repellent measures. 

Sometimes advantage will accrue from a strong impres- 
sion upon the nervous system by means of the metallic 
tonics, associated with the narcotics. Nitrate of silver, 
sub-carbonate of iron, sub-nitrate of bismuth, the salts of 
copper, or those of zinc, may be given in connection with 
the extract of belladonna, of stramonium, or of hyoscya- 
mus, or of the three combined. For the periodical cases, 
sulphate of quinine is the appropriate remedy. The 
paroxysms, when apt to occur at bedtime, may sometimes 
be effectively anticipated by a full dose of opium. 

Nor should local remedies be neglected in the intervals. 
Issues in the thighs have been highly recommended. Blis- 
tering, antimonial pustulation, setons, or issues may be em- 
ployed on the back between the shoulders. Advantage has 
also accrued from a belladonna plaster upon the breast. 

Finally, in very obstinate cases, not attended with seri- 
ous structural disease of the heart, much good may be ex- 
pected from travel, which places the nervous system under 



ARTERIAL PALPITATION. 577 

wholly new influences, and often subverts those tenacious, 
morbid associations which sustain if they do not originate 
neuralgia. 

ARTERIAL PALPITATION. 

This name is given to an increased pulsation or throbbing 
in the arteries, w 7 hich can be felt by the individual affected. 
It bears the same relation to the ordinary state of these 
vessels that palpitation of the heart does to the healthy 
action of that organ. It may occur in any of the larger 
arteries, but is most frequent in the aorta, especially in that 
portion of it w T hich is opposite to the pit of the stomach. 
It is only in the abdominal aorta that it has attracted par- 
ticular attention, or requires especial notice here. 

Symptoms. — Upon the application of the hand to the epi- 
gastrium, the throbbing is distinctly felt, and so violent is 
it occasionally that it may even become sensible to the eye. 
Though not usually attended with pain, it is often very an- 
noying to the patient, and sometimes occasions harassing 
fears of serious organic disease. It is in general intermit- 
tent in its character, occurring in paroxysms, which, how- 
ever, are altogether irregular, both in their degree and the 
period of their recurrence. In some instances it remains 
pretty constant for a considerable length of time. 

Causes. — It depends on a great variety of causes. Indeed, 
whatever is capable of extending an irritation to the great 
sympathetic nerve, and especially to the solar plexus and 
its ganglia, seems to be capable of producing it. The per- 
sons in whom it is most apt to occur are those of a highly 
nervous temperament. Hypochondriacal, hysterical, and 
anemic individuals are peculiarly susceptible to it. 

Treatment. — The primary object must be to search out 
the derangement, functional or organic, in which it may have 
originated, and to apply remedies to this derangement. The 
condition of the liver, of the stomach, of the bowels, and 
of the abdominal contents generally, should be carefully 
examined, and corrected by appropriate means, if found 
deranged. Should evidences of inflammatory congestion or 
irritation exist in the spine, or should there appear good 



578 FUNCTIONAL DERANGEMENTS. 

reason for suspecting its existence in the solar plexus, cups 
or leeches applied to the back, followed by blisters or other 
revulsives, would be the proper remedies. In anemic cases, 
a plan must be adopted, consisting in the use of chalybeates 
and a nutritious animal diet. Care must be taken also to 
arrest all exhausting discharges. Sometimes narcotic and 
antispasmodic medicines become necessary to allay nervous 
disorder. For this purpose, hyoscyamus, conium, lactuca- 
rium, camphor, valerian, assafoetida, musk, or compound 
spirit of sulphuric ether, and sometimes opium, may be re- 
sorted to. The cold shower-bath will occasionally prove a 
useful adjuvant. If the patient is much troubled with flat- 
ulence, a iTuiddrachm of one of the aromatic tinctures, as 
the compound spirit of lavender, or the compound tincture 
of cardamom, or a draught of strong infusion of ginger, will 
often dissipate the symptoms. The use of tobacco, coffee, 
and strong tea should always be abandoned, or at least sus- 
pended for a time, till it is ascertained whether they may 
not have been the cause. Exercise, fresh air, agreeable 
mental occupation, cheerfulness of spirit, and, as the most 
effectual method of combining these requisites, a journey 
to some public watering-place, especially to one of the cha- 
lybeate and saline springs, will be among the most effectual 
means of cure. 

PLETHORA. 

A morbid increase of the blood beyond the wants of the 
system is called plethora. It is not, however, a mere aug- 
mentation of volume in the circulating fluid that is entitled 
to that name. This may result from an excess of watery 
fluid, and is not incompatible with the state of anaemia, 
which is the opposite of that of plethora. There must be 
a morbid increase of those constituents of the blood upon 
which its nutritive and stimulant properties depend, and to 
which it owes its peculiar character ; such as the red glob- 
ules, fibrin, and albumen. There may or may not be an 
increase of bulk. 

There is no precise proportion of the active principles of 
the blood which is alone compatible with health. Their 



PLETHORA. 579 

quantity constantly varies with the varying sources of sup- 
ply and extent of consumption; and, within certain limits, 
no inconvenience is experienced from this irregularity. 
Even when derangement of function results from an excess 
of blood, if it be moderate, and speedily relieved, as very 
often happens, by an increased activity of secretion, or a 
diminished vigor of the process of sanguification, or blood- 
making, the excess scarcely deserves to be considered mor- 
bid. It is only when the derangement is threatening or 
very inconvenient, or continues long without relief, that the 
affection would come under the designation of plethora. 

It is not necessary that there should be an absolute in- 
crease of the blood, in order to the existence of the disease. 
The quantity may remain precisely the same, and yet, if 
the wants of the system for the support of its various func- 
tions should diminish, the phenomena of plethora may 
result ; for it is the loss of balance between the supply and 
consumption, the former being in excess, that constitutes 
the affection. 

Symptoms. — Florid cheeks, and redness of the lips, tongue, 
conjunctiva, and mucous surfaces generally, wherever visible, 
are usually considered as evidences of plethora, and they 
frequently are so ; but they are also occasionally wanting, 
when the capillaries are from any cause inactive, or the 
excess is not so much in the red globules as in the other 
active constituents of the blood. The pulse is ordinarily 
full, strong, and somewhat accelerated. When the affection 
is moderate, there is a slight feeling of heaviness, mental 
and bodily hebetude, and disposition to sleep; which in- 
creases, in severe cases, and is attended with a sense of 
fulness or tension in the head, vertigo, tinnitus aurium, or 
headache, and sometimes palpitations of the heart and 
oppressed breathing. Bleeding from the nose or rectum is 
not uncommon. Blood drawn from the arm is often more 
highly colored than in health, and affords a larger coagulum, 
with comparatively little serum. It seldom exhibits the 
buffy coat, unless the affection be complicated with inflam- 
mation. Plethora is said by writers to be frequently at- 
tended with obesity. This may occasionally be the case; 



580 FUNCTIONAL DERANGEMENTS. 

but, though the habit is often full, I have not usually found 
plethoric patients fat, and not unfrequently they are quite 
thin; the very deficiency in the nutritive function being 
probably one of the causes of the excess of blood. The 
copious secretion of adipose matter has a tendency to keep 
down any plethoric accumulation to which the individual 
may be predisposed. 

Causes.- — A loss of equilibrium between the supplying 
and expending processes is the immediate cause of plethora. 
Digestion and absorption are relatively more vigorous than 
nutrition and secretion. The former processes may be 
healthy, while the latter are defective ; or the former may 
be in excess, while the latter are healthy ; or both may be 
deranged in different directions, and thus cooperate to the 
same result. Whatever occasions this loss of equilibrium 
is a remote cause of the disease. Excessive eating, espe- 
cially of animal food; stimulating condiments or drinks, 
which excite digestion into preternatural activity ; and indo- 
lent or sedentary habits, which occasion a deficient expendi- 
ture of blood in the various vital processes, are, singly or 
conjointly, the most efficient agents in the production of 
plethora. It is especially apt to result, when long-continued 
active exercise is suddenly followed by a sedentary life. 
The invigorated appetite and digestion produced by the 
former continue for a while after its cessation, and throw 
copious supplies into the circulation ; while the previous 
expenditure is cut short or diminished, in consequence of 
the want of bodily activity. Continued moderate warmth, 
especially following cold weather, sometimes gives a morbid 
vigor to the process of sanguification. Hence, the system 
is apt to become plethoric in spring. Certain constitutional 
influences have the same effect ; such, for example, as preg- 
nancy, which is often attended with plethora. Some indi- 
viduals have a peculiar tendency to the over-production of 
blood, and become plethoric without any assignable cause ; 
and these are of course most readily affected by ordinary 
causes. Whatever checks secretion may give rise to the 
complaint. Cold sometimes probably acts in this way. The 
sudden stoppage of an habitual discharge, to which the sys- 



PLETHORA. 581 

tern has accommodated itself, is an occasional cause. Hence, 
in part, the accidents which follow the drying up of long- 
continued issues, the healing of old ulcers, the cessation of 
habitual hemorrhage from the nostrils, rectum, or uterus, 
and the omission of venesection after its frequent employ- 
ment at certain intervals. From what has been said it 
might be inferred that plethora is more common in females 
than males ; and such is asserted to be the fact. Children 
are thought to be less subject to it than adults, in conse- 
quence of the vigor of their nutritive process. Perhaps 
the period at which it is most apt to occur is that of ap- 
proaching maturity, when the body ceases to expand, and 
the processes concerned in sanguification have not yet fully 
adapted themselves to the new condition of the system. 

Treatment. — In the treatment of plethora, reference must 
be had to its duration. If it be temporary, and not im- 
moderate, it will be sufficient to restrict the diet to vegeta- 
ble food exclusively, or to this along with milk, to administer 
refreshing and mucilaginous drinks, and to keep the bowels 
freely open by saline laxatives. Should the symptoms be 
in any degree alarming, threatening apoplexy, for example, 
or indicating dangerous pulmonary congestion, the lancet 
should be resorted to, and employed with a freedom corre- 
sponding to the danger. There is some hazard, however, in 
a too frequent resort to venesection in this complaint. The 
system accommodates itself at length to the repeated losses 
by a proportionate increase in the activity of sanguification ; 
and if, under these circumstances, the abstraction should be 
inadvertently omitted, serious hemorrhages or other lesions 
might ensue. In cases of a protracted character, where the 
tendency to plethora is such that an excess is generated 
almost as fast as relieved by depletion, the lancet is admis- 
sible only to obviate immediate danger. The cure is to be 
effected here by a careful removal of all the causes ; by a 
regulation of the diet, the avoidance of stimulants and tonics, 
and frequent bodily exercise, of a kind not calculated greatly 
to excite the heart. In relation to the food, the abstemi- 
ousness should be in proportion to the obstinacy of the case. 
The patient should not sleep too warmly, and mattresses 



582 FUNCTIONAL DERANGEMENTS. 

are therefore preferable to feather-beds. He should also 
avoid confinement in overheated apartments. The secre- 
tions should be sustained. If the skin is dry and the 
capillaries inactive, advantage will accrue from the occasional 
use of the warm bath and moderate friction to the surface. 
Scanty urine may be relieved by cold drinks, with the aid 
of saline diuretics, especially bitartrate of potassa. Consti- 
pation must be obviated by the refrigerant laxatives. But 
the most important remedies by far will be found in diet and 
exercise properly regulated. 

ANAEMIA. 

By anaemia is understood a morbid deficiency or poverty 
of the blood. It is not necessary that there should be a 
deficiency in the volume of the circulating fluid. On the 
contrary, this is often quite as great in the disease as in 
health, and perhaps sometimes even greater. But in such 
cases the nutritive constituents of the blood are in less than 
their regular proportion, while the watery part is in excess. 
Any condition of the blood would come under our notion 
of this disease in which, either from deficiency in its general 
amount, or want of due proportion in its nutritive and 
stimulant ingredients, the functions of the body should be 
deranged in a considerable degree or for a considerable length 
of time. 

There are two forms of this disease, one suddenly and 
the other gradually introduced. The former may be called 
acute , the latter chronic ancemia. Under these names they 
are here considered. 

ACUTE ANEMIA. 

This consists in a sudden diminution of the mass of blood, 
produced by copious bleeding or profuse hemorrhage. The 
whole volume of the blood is lessened, while its ingredients 
bear to each other the ordinary relation. It has its origin 
usually either in venesection, spontaneous hemorrhage, rup- 
tured aneurisms, ulceration or sloughing of the larger ves- 
sels, bleeding from wounds, or flooding in child-birth. The 
treatment consists of means calculated to arouse the failing 



CHRONIC ANiEMIA. OR CHLOROSIS. 583 

or suspended actions of life, and, when immediate danger is 
passed, of such as tend to supply the deficient blood. 

CHRONIC ANAEMIA, OR CHLOROSIS. 

This is a not unfrequent attendant upon other diseases, 
which have the effect of impairing the processes of diges- 
tion and sanguification, or draining the system of its blood ; 
but it also appears to have occasionally an independent 
existence. It therefore merits distinct consideration. One 
of its most ordinary forms is that usually designated by the 
name of chlorosis, or green-sickness. Some authors consider 
this as a distinct affection from true anaemia ; but even these 
place its characteristic feature in poverty of the blood ; and 
it would be difficult to point out a single essential phenome- 
non in the complaint which may not be traced to that source. 
The circumstance that it generally occurs in girls or young 
unmarried women would only prove that there are circum- 
stances in their situation peculiarly operative in the produc- 
tion of the disease, and not that there is any thing peculiar 
in the disease itself. Nor is chlorosis confined to girls, or 
even to the female sex. The authors who treat of it as a 
distinct affection, acknowledge that it is sometimes met with 
in married women and in males of delicate constitution, 
especially about the age of puberty. In these latter cases, 
there is scarcely a shadow of distinction between it and 
ansemia, proceeding from causes which leave no doubt as to 
its nature. I shall therefore consider it under the present 
head. 

Symptoms. — When the complaint is fully formed, there is 
commonly universal paleness of the skin ; the lips, tongue, 
and mucous surfaces in general are also strikingly pale; 
there is extreme whiteness of the conjunctiva ; and the 
whole surface of the body appears bloodless. Sometimes 
the face is yellowish or sallow, and has a waxen aspect. 
With this change of color, there is often a pufhness of the 
face, especially of the eyelids ; the skin seems semi-trans- 
parent, and when the fingers are held up, the light shines 
through their edges. The lower extremities are apt to be 
edematous. The patient is feeble, and cannot bear much 



584 FUNCTIONAL DERANGEMENTS. 

exertion, to which also he is usually indisposed. The cir- 
culation is irregular, but almost always weak. The pulse is 
often full, frequent, and thrilling or vibrating ; but it is soft, 
and easily compressed, showing a want of energy in the 
heart's impulse. It is almost always greatly quickened by 
bodily exercise or mental emotion. When the patient is 
entirely quiet and in a recumbent posture, it is often small, 
rather slow, and feeble. Palpitation of the heart is a very 
common symptom. It is sometimes continuous, sometimes 
irregularly intermittent, and may be induced by the slight- 
est causes, mental or physical. Violent exertion often 
throws the heart into the most tumultuous action. Pulsa- 
tion in the carotids and jugular veins is often obvious. The 
respiration, though quiet when the patient is at rest, becomes 
hurried and even painfully agitated under exertion, as in 
running, ascending heights, etc. The nervous system is 
often greatly disordered. Vertigo, dizziness, and a feeling 
of faintness are very common; and spasmodic movements 
of the muscles, sometimes amounting to convulsions, are not 
unfrequent, especially in females. Violent and obstinate 
neuralgic pains in the head, side, breast, or other part of the 
body, are also frequent attendants upon the disease. The 
secretions are sometimes diminished ; and, associated with 
this condition, are extraordinary dryness of the skin, brittle- 
ness of the nails, and harshness of the hair. In other 
cases, on the contrary, there are profuse and exhausting 
sweats. In females, the menses are almost alwavs either 
altogether wanting or greatly deficient, being scanty and 
light-colored or even serous. The bile is also frequently 
scanty ; and costiveness, with unhealthy alvine evacuations, 
and a dyspeptic state of stomach, are extremely common 
symptoms. 

In its earlier stages, the disease is usually very manage- 
able, and, when there are no organic complications, and the 
patient can be withdrawn from the continued influence of 
the causes, may in general be cured, or at least placed in a 
fair way of recovery, in a period of time varying from two 
to four weeks. Under opposite circumstances, and espe- 
cially when improperly treated, it may terminate fatally. 



CHRONIC ANEMIA, OR CHLOROSIS. 585 

When long continued, it is apt to induce dropsy, and proba- 
bly also organic disease of the heart. The excessive action 
into which this organ is constantly thrown by the calls from 
the capillaries for a more rapid current of blood to supply 
the deficiency of nutritive material, leads to its enlargement, 
while defective nutrition renders it soft and flabby. 

In the treatment of this disease it is of the utmost im- 
portance to remove the causes. While these continue to 
act, the use of remedies will be of only temporary benefit. 
Should the digestive system be in disorder, it must be cor- 
rected ; constipation must be obviated ; any hemorrhage or 
other drain which may exist must be arrested ; the menses, 
if retained, suppressed, scanty, excessive, or otherwise 
irregular, must be restored to the healthy state ; and, in 
general, any other existing disease which may impair the 
digestive and assimilative processes, or debilitate the system 
at large, must, as far as possible, be removed. The modes 
of treatment which may be necessary for these purposes 
are given under the heads of the affections respectively to 
be corrected, and need not be repeated here. The closest 
attention must be paid to the peculiar circumstances of the 
patient ; and whenever any moral cause can be discovered to 
which the complaint may in part or wholly be ascribed, 
efforts should be made to obviate its influence. Moderate 
exercise in the open air, and especially on horseback, should 
be encouraged ; the patient should sleep in well-ventilated 
apartments ; and the ill effects of irregularities of tempera- 
ture should be prevented by flannel next the skin. All 
these measures, by invigorating the general health, will have 
a tendency to produce a more copious supply of well-condi- 
tioned blood. The same end will be promoted by a nutri- 
tious and digestible diet, such as that recommended in cases 
of dyspepsia. 

The medicines best adapted to the disease are tonics, and 
especially the chalybeates, which, besides an invigorating 
influence over the process of digestion and the vital pro- 
cesses generally, have a peculiar power of increasing the 
richness and redness of the blood, by an operation not 
exactly understood. They produce, indeed, the very effect 



586 FUNCTIONAL DERANGEMENTS. 

that is most wanted in this disease — an augmentation, 
namely, of the proportion of red corpuscles. Hence the 
preparations of iron have been long considered almost as 
sovereign remedies in chlorosis. It matters little which of 
the preparations is employed, provided the iron finds access 
into the system. That one should be selected which irri- 
tates the stomach least, and is most readily absorbed. The 
preparation of burnt copperas and elecampane root, given 
under the head of Dyspepsia, is the form I have found most 
successful ; but the common domestic form of vinegar and 
nails answers very well when the stomach can take it. When 
the case is one of pure anaemia, the chalybeates alone, 
united with a proper diet, will be sufficient for the cure. 
But when the digestion is feeble, they may be advan- 
tageously combined with the simple bitters, such as the 
extracts or infusions of gentian or quassia, and the powder 
or infusion of columbo; and the combination will be 
rendered more acceptable to the stomach by the conjunction 
of some aromatic, as ginger or cinnamon. Mild laxatives 
may be added in cases of constipation ; and of these, when 
uterine disorder is not involved, the best is rhubarb. But 
if amenorrhoea exist, aloes is the appropriate laxative, and 
should be given with each dose of the chalybeate in the 
quantity of one or two grains. The mineral acids are 
sometimes useful when the appetite is very languid ; and if 
the liver is functionally deranged, the nitro-muriatic acid 
should be selected. But care should be taken that they do 
not prove injurious by a chemical incompatibility with the 
particular chalybeate employed. Nervous derangements 
may be combated by the occasional use of the antispasmo- 
dics, especially valerian and assafoetida, and of the narcotic 
extracts, such as those ol hyoscyamus and conium. The 
anodyne alterant (see Dyspepsia) answers most admirably 
in these cases. The severe neuralgic pains which often 
attend the complaint may be relieved by chloroform lini- 
ment or blisters applied near the seat, of the affection, and, 
if necessary, sprinkled with morphia after the removal of 
the cuticle. 

It will often be found useful, in order to hasten or con- 



PURPURA. 587 

firm convalescence, or even as a remedy in obstinate cases, 
to send the patient upon excursions to chalybeate springs 
at a distance from home, so as to combine with the medi- 
cinal effect of the iron the happy influences of exercise, pure 
air, novelty of scene, and the enjoyments of agreeable 
society. Unless complicated with serious organic lesions, 
the disease may generally be cured, or very materially 
relieved, by the means above detailed, in a period of time 
varying from two to six weeks. 

SCORBUTUS, OR SCURVY. 

Scurvy may be defined to be a disease in which the 
blood is depraved, and the system debilitated, with a ten- 
dency to hemorrhage and petechia, and to local congestion 
or feeble and imperfect inflammation in various parts of the 
body, but especially in the gums, and without any neces- 
sary febrile complication. There can scarcely be a doubt 
that its essential character is an altered state of the blood, 
arising from want of proper nourishment, and that all its 
phenomena flow directly or indirectly from that source. 
As this disease is never seen in this plentiful country, even 
among the most destitute poor, we will not occupy space 
with a detail of its symptoms and treatment, but will refer 
the reader to regular works on the practice of medicine. 

PURPURA. 

Purpura consists of a morbid condition of the capillaries, 
owing to which blood is effused into the different tissues of 
the body, the effusion giving rise to the formation of 
sanguineous patches of various sizes. 

The spots vary in color, being either red, purple, livid, or 
reddish-brown ; they bear a great resemblance to bruises ; 
pressure does not efface them. This disease must not be 
confounded with scurvy, which it somewhat resembles. It 
differs, however, inasmuch as it often appears suddenly, is 
not owing to any want of vegetable food, and is not attended 
by a livid, spongy state of the gums. 

As purpura is a disease of debility, the treatment must 
consist in the use of good diet ; tonics will also be required, 



588 FUNCTIONAL DERANGEMENTS. 

especially the mineral acids, quinine and iron, and acidulous 
drinks. The oil of turpentine, in small, frequently repeated 
doses, has been strongly recommended. 

HEMORRHAGE. 

By hemorrhage is meant an escape of blood from the 
vessels in which it is contained. 

In active hemorrhages, signs of irritation or active con- 
gestion, in the part affected, often precede the eruption of 
the blood. These are somewhat different in different 
organs. Among them are, a sense of oppression, fulness, 
weight, warmth, titillation, and even pain; and when the 
part is visible, an obvious redness, vascular distention, and 
increased force of pulsation in the neighboring arterial 
trunks. Simultaneously with these symptoms, coolness of 
the extremities, and rigors sometimes occur, followed by 
febrile reaction ; and both the local and general disturbance 
continues usually, to a greater or less extent, for some time 
after the first appearance of the hemorrhage, though the 
discharge has a tendency to relieve it. The blood is usually 
bright red and coagulable ; but the clot is in most cases 
large and soft. Active hemorrhage occurs only from one 
organ, and not from various parts of the body at the same 
time, as often happens in passive hemorrhages. The affec- 
tion occurs most frequently in young, robust, and florid 
individuals, accustomed to full living, without sufficient 
exercise ; circumstances Avhich strongly favor the production 
of a plethoric state. But it is not unfrequent also in a 
very different habit of body ; in meagre and delicate per- 
sons, in whom there is a rapid production of blood, in con- 
sequence of a vigorous digestion without a corresponding 
tendency to its expenditure in the process of nutrition. 
When not associated with organic disease, active hemorrhage 
in general readily yields to treatment. 

Passive hemorrhages are neither preceded nor attended by 
local or general excitement, unless some other disease exist 
at the time, such as a malignant fever, of which the hemor- 
rhagic affection is a mere accompaniment ; and even in such 
cases, the excitement is of a feeble character, such as is 



HEMORRHAGE. 589 

produced by some irritant or stimulant influence operating 
upon real debility. On the contrary, the symptoms are 
those of a depressed condition alike of the vital forces and 
vital actions. There is a feeling of languor, a deficiency of 
muscular strength, and weakness of the circulation, though 
the pulse is sometimes more frequent than in health, espe- 
cially during exertion. The capillaries are indolent; the 
blood circulating very slowly through them, and imparting, 
in consequence of its stagnation, a somewhat dark hue to 
the surface, which is otherwise pale. Pressure often occa- 
sions the marks of a bruise, and slight contusions give rise 
to ecchymosis. The blood which escapes is dark-colored, 
sometimes almost black, and little disposed to coagulate, or 
altogether uncoagulable. The serum and clot separate but 
imperfectly, and the latter is seldom or never cupped. The 
fibrin is deficient, while the red corpuscles are undiminished. 
Sometimes the blood is like reddish serum. The hemor- 
rhage is not usually confined to one organ; but blood 
escapes at the same time from different points of the 
mucous surfaces, and is not unfrequently extravasated into 
or beneath the skin, forming petechise and ecchymoses. 
The affection is much less frequently original than attendant 
on other diseases, as malignant small-pox and scarlatina, 
typhus fever, scurvy, and hemorrhagic purpura. 

When hemorrhage is considerable, it usually produces 
signs of depression, such as weakness of pulse, paleness of 
face, coolness of the extremities, nausea, faintness, vertigo, 
and cold sweats ; when sudden and very copious, it may 
even induce syncope, preceded in some instances by con- 
vulsions. But the depression of the circulation usually 
causes a suspension of the hemorrhage before it reaches the 
point of absolute syncope. The fears of the patient not 
unfrequently cooperate with the loss of blood in producing 
signs of depression ; and sometimes, when the hemorrhage 
is too slight to be capable of producing directly any consti- 
tutional effect, great paleness and apparent prostration result 
from the former cause alone. The ultimate effects of pro- 
fuse or often-repeated hemorrhage, are those described 
under the head of Anjsmia. 



590 FUNCTIONAL DERANGEMENTS. 

Hemorrhage is very apt to return after being arrested, in 
consequence of the persistence of the causes in which it 
originated. Generally, the periods of its return are alto- 
gether irregular, depending on the casual influence of 
exciting causes during the continuance of the predisposition. 
Sometimes it assumes a periodical form, returning at certain 
stated intervals. When it occurs once a year, as occasion- 
ally happens, the result may be reasonably ascribed to the 
influence of the season ; when daily, or every other day, it 
is probably under the operation of those causes which lead 
generally to periodicity in disease. The most common 
interval is that of a month ; and this is most frequent in 
females, with suppression of the menses, in whom the 
hemorrhage may be considered as vicarious to that dis- 
charge. Even in men there is sometimes a monthly recur- 
ring hemorrhage, especially from the hemorrhoidal vessels, 
which seems designed to relieve a periodical plethora, and 
may be considered, therefore, as entering into the health of 
the individual. Some believe that, in the male as well as 
the female system, there are a monthly flux and reflux of 
vital action, which sometimes becomes excessive at the full, 
and relieves itself by some discharge, especially by hemor- 
rhage. In such cases, the same premonitory symptoms are 
exhibited as by women before menstruation ; and the same 
dangers are incurred by the suppression of the discharge. 
Another analogy between this form of hemorrhage and 
menstruation is, that it is apt to cease spontaneously at a 
certain period of life. 

By the frequent repetition of hemorrhagic discharges, 
even when of accidental origin, the system sometimes 
becomes, at length, habituated to them. The processes of 
digestion and sanguification acquire an activity which serves 
to secure the health against material injury, by supplying 
an additional quantity of blood equal to that lost. The 
hemorrhage then almost ceases to be morbid ; and its hasty 
suppression would endanger plethora, and consequent 
hemorrhage in other and perhaps more hazardous situations. 
Thus, the suppression of an habitual discharge of blood 
from the rectum may cause haemoptysis, or a fatal apoplexy. 



HEMORRHAGE. 591 

In some persons a strong constitutional tendency to 
hemorrhage exists, so much so that the slightest causes will 
often bring on an attack ; and when the blood begins to 
flow, it is exceedingly difficult to arrest it. A slight 
wound, even the scratch of a pin, will sometimes occasion a 
serious and even alarming hemorrhage. 

Near the termination of certain diseases, or at certain 
periods in their course, hemorrhage sometimes occurs, with 
the apparent effect of relieving the morbid action, and even 
of pul ting an end to the complaint. The discharge, how- 
ever, may prove too copious, and, instead of relieving, may 
aggravate the danger, and even lead to a fatal result. Such 
hemorrhages have been called critical. They differ, how- 
ever, in nothing from ordinary hemorrhages, which are almost 
always the result of a morbid state of the system preceding 
the attack, and not unfrequently serve to remove that 
state. The only apparent difference is, that, in the one 
case, the antecedent disease is obvious and well known, in 
the other is perhaps concealed. 

Hemorrhage is seldom fatal by its immediate effects, un- 
less in cases of organic disease of the vessels, as in aneur- 
ism; or where the escape of the extravasated blood is 
prevented, and the functions of vital organs are interfered 
with by its accumulation, as in apoplexy. 

Treatment. — The first consideration, in the treatment of 
hemorrhage, is how far its diminution or suppression is 
desirable. When it is situated in a safe place, and at the 
same time appears to have the effect of relieving some pre- 
existing morbid affection, more serious than the hemorrhage 
itself, great caution should be used in employing measures 
for arresting it. Under such circumstances, it should, in 
general, be allowed to run its course without interruption. 
It would be hazardous, for example, to arrest a bleeding 
from the nose which might appear to be rescuing a patient 
from apoplexy. Indeed, if the hemorrhage be deficient, it 
may be desirable somewhat to promote it, and, if prema- 
turely arrested, to favor its return by the application of 
hot water or hot vapor to the part. Should the bleeding, 
on the contrary, be in excess, it would be proper to mode- 
38 



592 FUNCTIONAL DERANGEMENTS. 

rate it ; and, should it continue after having accomplished 
the object desired, efforts should be made to arrest it. In 
all cases, when the hemorrhage is in itself dangerous from 
its situation, we should endeavor to check it ; at the same 
time employing other measures for obviating any evil which 
it may have been calculated to remedy. Thus, bleeding 
from the nose or the rectum may often be left to its course 
with impunity and even advantage ; but from the stomach 
or lungs, and especially in the closed cavities, should in 
general be subjected to treatment. 

Cold water or ice may be applied as near to the seat of 
hemorrhage as possible. A powerful effect is sometimes 
produced by this application made to the arm-pits, between 
the shoulders, or to the external genitals. The local ab- 
straction of blood by leeches or cups is often highly useful, 
when the hemorrhage is accompanied with symptoms of 
local irritation or active congestion. Advantage may also 
be derived from warm pediluvia ; and the effects of revul- 
sion may be usefully produced by means of rubefacients or 
blisters to the extremities. 

When hemorrhage is at the beginning without excite- 
ment, or when the excitement has been subdued and the 
hemorrhage continues, recourse may be had to astringent or 
other remedies, which operate upon the capillaries, and 
close their bleeding orifices. If the hemorrhage is very 
profuse, even though accompanied with general excitement, 
it may be necessary to resort to some of these remedies 
immediately; and, under such circumstances, those should 
be preferred which unite a sedative with their astringent 
property, as the acetate of lead, or which diminish action in 
the capillaries without materially affecting the circulation, 
as appears to be the case with ergot. These may be com- 
bined, in cases of excitement, with small quantities of 
ipecacuanha. The particular remedies of the class of 
astringents which are applicable to particular cases, will be 
mentioned under the head of the several hemorrhages. It 
is here sufficient to say, that almost all the individuals be- 
longing to the class, whether vegetable or mineral, have 
been used with more or less advantage. The only hemos- 



HEMORRHAGE. 593 

tatic remedies not belonging to this class, which I deem 
worthy of notice, are the oil of turpentine and ergot, both 
of which exert an extraordinary influence, under certain 
circumstances, in arresting hemorrhage. 

In connection with the remedies just mentioned, great 
benefit will often accrue from the use of opiates, or other 
narcotic medicines, such as hyoscyamus or conium. They 
are useful by quieting nervous commotion, and thereby 
equalizing the circulation, and frequently also by relieving 
those slight irritations of a nervous character which tend to 
sustain the hemorrhage, such as cough in haemoptysis, and 
excessive retching in haematemesis. Opium is useful also 
by directing to the surface, and this tendency should be 
favored by combining it with ipecacuanha or tartar emetic. 
Opium and ipecacuanha may often be very happily con- 
joined with one or more of the astringents, in the same 
formula. 

In cases to which the internal use of astringents is appli- 
cable, the same remedies may also often be very advan- 
tageously applied locally, when the seat of hemorrhage can 
be reached in this way, as in bleeding from the nose and 
rectum. Recourse may also be had, in some instances, to 
mechanical compression, with very decisive results, when 
other measures have failed. 

In the strictly passive hemorrhages, remedies of a deple- 
tory character are inadmissible. The astringents and other 
hemostatics may here be brought into immediate use ; 
while, at the same time, efforts are made to give due tone 
to the capillaries, to support the actions of the system in 
general, and to improve the character of the blood, by the 
use of tonics and, stimulants, with a generous diet. 

In vicarious hemorrhages, as the substitute is often more 
hazardous than that which it has superseded, it is often ad- 
visable to endeavor to restore the original discharge, by 
inviting a flow of blood to the part. This may be done by 
the use of hot vapor, local warm baths, and various stimu- 
lating applications, as alcohol, ammonia, etc. The same 
rule applies, when the hemorrhage has resulted from the 



594 FUNCTIONAL DERANGEMENTS. 

suppression of some healthy secretion, as the menses, or 
the drying up of some habitual discharge, as that from old 
ulcers, etc. In the latter case, perpetual blisters or issues 
should be established as near as possible to the original seat 
of disorder. When it is thought advisable to restrain or 
altogether arrest an habitual hemorrhage, which has become 
constitutional, measures should be simultaneously taken to 
supply the place of the suppressed evacuation by means of 
purgatives, blisters, issues, setons, etc. 

The treatment of those hemorrhages which proceed from 
a strong constitutional, family, or hereditary predisposition, 
must be conducted upon general principles. 

The treatment adapted to the interval of the attacks of 
hemorrhage remains to be- considered. Here also it is 
necessary to refer to the state of the system. In active 
hemorrhage, it is important to regulate the diet, so as to 
obviate plethora and vascular excitement. But it is also 
important not to carry a system of reduction so far as to 
produce debility; for this rather favors than prevents those 
irregularities in the circulation which lead to congestion and 
consequent hemorrhage. The quantity of food, and its 
quality in relation to nutrition and stimulating power, 
should be somewhat under the standard adapted to a state 
of health. Exercise is also important, in order to maintain 
an equable vigor in the various functions, and thus obviate 
local determinations. Passive exercise, as in riding, driv- 
ing, and sailing, is preferable to active, because less calcu- 
lated to call particular organs into excessive action. All 
excitements, physical or mental, should be scrupulously 
avoided. 

In the passive form of hemorrhage, the great object in 
the intervals should be to restore vigor to the functions 
without over-exciting them, and a healthy constitution to 
the blood. This is to be effected by a nutritious diet, fresh 
air, passive exercise, and agreeable mental occupation, 
assisted occasionally by tonic medicines, especially the 
simple bitters, quinine, and the preparations of iron. 



PARTICULAR HEMORRHAGES. 595 



PARTICULAR HEMORRHAGES. 



After what has been said upon Hemorrhage in general, it 
is not necessary to dilate upon particular cases, but as most 
of these admit of some peculiarity of treatment, they will 
be run over in order, and very cursorily considered. 
Hemorrhage from the mucous membrane will first be con- 
sidered, as that is by far the most common. 

EPISTAXIS, OR BLEEDING AT THE NOSE. 

Young persons are very subject to this ; their digestive 
organs being usually very active, and a rapid generation of 
blood being the consequence, the over-distended capillaries 
relieve themselves by throwing off the blood through the 
numerous pores in the delicate lining membrane of the 
nostrils. Usually this is a very innocent form of hemor- 
rhage, and requires no treatment, except, should it be pro- 
fuse, or continue too long, when the usual popular remedies 
will generally be sufficient, such as cold, applied directly to 
the nose, or to the back of the neck, or to the genitals. 
But should these fail, then immerse the feet and legs in 
water, as hot as it can be borne, and still continue the cold. 
Should this fail, at once resort to injections, into the nose, 
of a strong solution of alum ; and if it still continues, plug- 
up the nose with a piece of fat bacon. I have never known 
this last remedy to fail to stop the bleeding immediately. 
The meat should be trimmed so as to fit the nostril, and 
long enough to reach clear through to the fauces. This 
will give no pain, and will only, for awhile, feel a little 
unpleasant. 

In cases of much weakness, in which the hemorrhage is 
passive, every means which are calculated to improve the 
general tone of the system are indicated — such as sponging 
with cold water, good air, nutritious diet, gentle exercise, 
tonic bitters, iron in some form, cod liver oil, etc. 

STOMATTARRHEA, HEMORRHAGE FROM THE MOUTH. 

The bleeding in this case is commonly from the socket 
of a tooth, which should be packed with cotton or lint, 



596 FUNCTIONAL DERANGEMENTS. i 

saturated in strong alum water. If it proceeds from spongy 
gums, try the alum water, and if this fails, make a strong 
decoction of oak bark, and add to it some essence of pep- 
permint. This should be used daily, with a soft tooth- 
brush, until the gums assume their proper firmness. 

HAEMOPTYSIS, HEMORRHAGE FROM THE LUNGS SPITTING OF 

BLOOD. 

This is always an alarming disease to the patient, and 
should therefore receive prompt attention; for notwith- 
standing it generally proceeds from the same cause as 
bleeding from the nose, and forebodes no more harm, yet 
the alarm it occasions, and the strong concentration of the 
mind upon the lungs, may prove serious in persons predis- 
posed to consumption by directing morbid action to this point. 

A teaspoonful of common salt, dissolved in half a pint of 
cold water, drank at once, will usually arrest it immediately. 
A powerful stimulant should also be applied to the chest, as 
a mustard plaster, chloroform liniment, equal parts of spirits 
of turpentine and camphor, etc. If it be vicarious, that is, 
occur in place of some other discharge, as ble-eding piles, or 
menstrual flux, that discharge should at once be restored. 

H^EMATAMESIS, HEMORRHAGES FROM THE STOMACH. 

Bleeding from the stomach may proceed, as from the 
nose, from an oozing of the blood through the pores of the 
mucous membrane, or it may come from ordinary ulcers, or 
from cancerous sores in the stomach; what we have to con- 
sider now is the bleeding. This may usually be promptly 
arrested by a draught of strong salt and water, or by flour 
and water. A teaspoon, heaping full, of wheat flour should 
be stirred in a glass of cold water, and drank at once. 

For the treatment of the condition which gives rise to 
the hemorrhage the reader is referred to the appropriate 
head, as inflammation of the stomach, cancer, etc. 

MJELENA, OR HEMORRHAGE OF THE BOWELS. 

Bleeding from the bowels is rarely an independent dis- 
ease, but is most commonly a symptom, or consequence, of 



HEMORRHAGE FROM THE RECTUM. 597 

some other disorder, as ulceration in typhoid fever, conges- 
tion of the portal circle, from induration of the liver. The 
quantity of the blood discharged may vary from a few 
drops to pints. In dysentery, it is usually scant; but in 
typhoid fever, it is often fatally profuse. 

I was once called to a young lady who had typhoid fever, 
and had commenced improving, when very suddenly hemor- 
rhage of the bowels came on — I suppose from an ulcer 
which had destroyed the coats of a considerable artery. 
When I arrived the blood was running from her in a bold, 
continuous stream, and had already amounted to more than 
half a gallon. I immediately poured cold water upon her 
abdomen, and gave a large draught of flour and water. 
The bleeding stopped in a little over a minute, and did not 
return. 

The proper treatment of this disease is cold applied 
externally, flour and water, a full dose of opium, and, if 
necessary, injections of cold water, with alum, or sugar of 
lead. 

.HEMORRHAGE FROM THE RECTUM BLEEDING PILES, OR HEMOR- 
RHOIDAL FLUX. 

When the bleeding comes from the lower part of the 
bowels, it may be treated as other cases of hemorrhage 
from the bowels; but we have in this case a better chance 
to operate, as we can apply the remedies directly to the 
bleeding surface by means of injections; and if these 
should fail, we may make direct pressure by means of a 
bougie or a piece of hog's gut, tied at one end, and pushed 
up the bowels, and then injected with cold water until its 
distention presses hard enough upon the blood-vessels to 
close their open mouths. 

HEMATURIA, OR HEMORRHAGE FROM THE URINARY ORGANS. 

The bleeding in this case may take place in the kidneys, 
ureters, bladder, or urethra. The bleeding is rarely pro- 
fuse, and usually is only important as indicating the exist- 
ence of some other disease ; it sometimes leads to serious 
consequences by a clot forming a nucleus for the forma- 



598 FUNCTIONAL DERANGEMENTS. 

tion of a stone in the bladder, or by plugging up the urethra, 
and preventing the passage of urine. In this case water 
should be freely and forcibly injected into the urethra to 
break up and wash out the clot, or a bougie may be used 
for pushing it back into the bladder. The same general 
means may be used in this case as in hemorrhage from the 
bowels. Injections of cold water and laudanum will often 
have a most happy effect. 

MENORRHAGIA, OR UTERINE HEMORRHAGE. 

Hemorrhage from the uterus may be distinguished from 
profuse menstruation by the blood coming away in clots. 
It requires no peculiar treatment, the remedies being the 
external application of cold, flour and water, followed by a 
full dose of opium, or Dover's powder, and if the flooding 
be dangerously profuse, by plugging up the vagina with soft 
cloths, saturated with alum water, or lead water. If the 
hemorrhage be habitual, it may often be prevented by 
giving a full dose of salts and soda a few days before the 
expected attack, and, on the appearance of the first symp- 
toms, giving five or six grains of Dover's powder, and 
repeating it every two hours, until all uneasiness is allayed. 

HEMORRHAGE FROM THE LIVER. 

In another place in this w r ork I have alluded to the pecul- 
iarity which exists in the circulation of the liver by which 
a large vein, upon entering that organ, subdivides and is 
distributed through its substance in the manner of an artery, 
by which arrangement the circulation in this viscus becomes 
necessarily slow and of feeble force, causing congestion to 
be easily produced, and thus congestion, when carried to a 
certain extent, will necessarily render a rupture of the deli- 
cate investing membrane of these vessels of easy occur- 
rence ; we consequently often have hemorrhage from the 
liver as a concomitant of all those forms of diseases which 
occasion great engorgement in what is known as the portal 
circle. 

The blood which is discharged in these cases is always 
dark and thick, being usually a good type of what is known 



HEMORRHAGE FROM THE SEIN. 599 

as grumous blood. This form of hemorrhage is very often 
salutary by directly relieving engorgement of the liver; 
but should it become excessive, it should be arrested by a 
sudden dash of cold water upon this part of the body, which, 
by causing a shock, will bring about a contraction of the 
blood-vessels, and thus arrest the hemorrhage. 

Very frequently what appears to be a hemorrhage from 
the liver is nothing more than a passing of the blood from 
the portal veins into the billiary ducts without having un- 
dergone the usual change which manufactures black bile from 
black blood; in this case the blood presents the appearance 
of being partially decomposed. In whatever disease this 
kind of discharge appears, it indicates a dangerous condi- 
tion, and should be met promptly by every means calculated 
to arouse a higher mode of action, such as the cold douche, 
powerful stimulating embrocations, or cataplasms, general 
stimulants, as alcoholic stimulants, ammonia, etc. 

HEMORRHAGE FROM THE SKIN. 

Bleeding from the pores of the skin is a very rare occur- 
rence, but it sometimes takes place. I once saw a very 
remarkable case in which the blood oozed from every part 
of the surface where the skin was thin, as the eyes, ears, 
arm-pits, etc. A bold administration of stimulants and 
opiates saved my patient. 

Effusion of blood into the cellular tissue is more common, 
as in purpura, and must be treated by stimulants and tonics. 
Sometimes the bleeding is of the active kind, and consider- 
able tumors are formed, which, if not speedily absorbed, 
may cause abscesses. These cases should be treated by 
friction and compression. 

Very rarely there is hemorrhage from the serous surfaces, 
as the pleura, pericardium, etc.; but as its existence can 
never be positively known until after death, I will not 
trouble the reader with their consideration. 



600 FUNCTIONAL DERANGEMENTS. 



CHAPTER IV. 

FUNCTIONAL DERANGEMENTS CONNECTED WITH THE ORGANS 0* 

SECRETION. 

This section might embrace all the derangements of all 
the secreting tissues, including the serous, cellular, and mu- 
cous membranes, the skin, and the conglomerate glands ; 
but many of these are more conveniently considered under 
other functions, in the execution of which the tissues per- 
form an essential part ; as, for example, the complaints of 
the alimentary mucous membrane under digestion, and of 
the bronchial under respiration, etc. I shall treat here only 
of the derangements of the serous and cellular tissues, the 
kidneys, and the appendages of these organs. No arrange- 
ment of diseases can be so precise that the different divisions 
will not occasionally trench upon one another. 

DROPSY. 

Dropsy may be defined to be a morbid accumulation of 
watery or serous fluid in the cellular tissue or serous cavi- 
ties. A certain portion of such fluid is essential to the 
healthy state of these parts. It is only when the wants of 
the tissues are exceeded, and an accumulation takes place 
productive of more or less inconvenience or injury, that it 
can be said to be morbid, and thus to constitute dropsy. 

When the effusion takes place in the cellular structure, it 
is denominated, if extensive, anasarca ; if limited to one 
part, oedema ; when it affects the arachnoid, it is called hy- 
drocephalus, or dropsy of the brain ; when the pleurae, hydro- 
thorax, or dropsy of the chest ; when the pericardium, hydro- 
pericardium^ or dropsy of the heart ; when the peritoneum, 



DROPSY. 601 

ascites, or abdominal dropsy. The name of general dropsy is 
given to the affection when it occupies all or most of these 
positions, to a greater or less extent, at the same time. The 
complaint will be first treated of in its general relations, and 
afterwards in the several localities alluded to. 

Dropsy is rather a symptom or result of morbid action 
than itself a disease. Nevertheless, it usually holds this 
rank in practical treatises, and, from its own striking char- 
acters, and the frequent obscurity of the true pathological 
condition in which it originates, will probably always con- 
tinue to do so. The danger in which it frequently involves 
life, and the consequent necessity of employing measures 
for its removal, without reference to its source, are other 
considerations which entitle it to a place in the catalogue of 
distinct diseases. 

Pathological Condition. — The first inquiry in relation to 
dropsy should be directed towards the pathological condition 
upon which the serous accumulation depends, and which 
constitutes the true disease. This is not the same in all 
cases. Very different, and indeed in some measure opposite 
derangements of function or structure, are the sources of 
dropsy. They may all be included under the following 
heads. 

Irritation, Active Congestion, or Inflammation. — The serous 
and cellular tissues, like all other organs of secretion, pour 
out an increased quantity of fluid when excited. This ex- 
citement may amount to inflammation. That dropsical 
effusion is sometimes associated with this condition of the 
membrane from which it proceeds, is evinced by the symp- 
toms during life, and the results of examination after death. 
Pleuritic and abdominal pains, with fever, occasionally pre- 
cede hydrothorax and ascites ; and in some cases of anasarca, 
pressure upon the edematous part occasions considerable 
uneasiness. Indeed, inflammation of the serous tissues is 
generally attended with a fluid exudation, a portion of which 
has the serous character. When this is speedily absorbed, 
after the subsidence of the acute symptoms, it is not con- 
sidered dropsical ; but if it continue long, and especially if 
it increase and become complicated with external oedema, it 



602 FUNCTIONAL DERANGEMENTS. 

is unhesitatingly admitted to that rank. Dissection aftei 
death, in such instances, often exhibits decisive evidence of 
preexistent or persisting inflammation. In most cases, the 
inflammation is of a chronic character, and it is not unfre- 
quently complicated with tubercles, which serve to sustain 
it. But, though inflammation sometimes lies at the founda- 
tion of dropsy, it is more frequently the result of mere 
irritation with vascular fulness. The very act of secretion 
relieves the vessels, and inflammation is prevented by the 
occurrence of dropsy. 

Debility or Relaxation. — An opposite condition of the tis- 
sues to that just mentioned may be productive of the same 
result in relation to dropsical effusion. The secretory ori- 
fices or pores are sometimes relaxed and become patulous 
in debility, allowing the more liquid portions of the blood 
to pass through, almost without resistance. We observe 
the same thing in the vessels of the skin, by which the 
watery part of the blood is often poured out abundantly, in 
very feeble states of the system, in the form of colliquative 
sweats. 

Passive Congestion. — Distention of the blood-vessels, un- 
attended with irritation, frequently results in serous effusion. 

The preternatural fulness of the blood-vessels may be 
general, affecting the whole circulation, or it may be confined 
to the venous system, or to some portion of it, as to the 
portal circle, for example, or to a single limb. When par- 
tial, it is apt to be the result of some impediment to the 
return of blood towards the heart. The character of such 
impediments will engage our attention when upon the sub- 
ject of the causes of dropsy. The extent and position of 
the dropsy will of course be influenced by the locality of 
the congestion. 

Altered Condition of the Blood. — There is little doubt that 
an altered composition of the blood is occasionally the true 
pathological condition in dropsy. What is the precise na- 
ture of the change has not been certainly determined. It 
is well known that anemic patients are occasionally attacked 
by dropsy ; and it has been supposed that a watery state 
of the blood favors the occurrence of the disease. 



DROPSY. 603 

Deficient Absorption. — In health there is a constant exha- 
lation from the serous and cellular tissues, and an equally- 
constant absorption of the effused fluid ; and the two pro- 
cesses so far balance each other that no injurious accumula- 
tion takes place. It is obvious that dropsy may arise from 
an irregular condition of either or both of these functions ; 
from an excess of exhalation, while absorption remains un- 
changed; from a deficiency of absorption, exhalation con- 
tinuing as in health ; or from an increase of exhalation and 
diminution of absorption combined. 

Symptoms, Course, Termination, etc. — The symptoms which 
characterize dropsical effusion will be more conveniently 
detailed under the particular forms of dropsy. The affec- 
tion sometimes comes on suddenly, with more or less febrile 
action, indicated by increased frequency and force of pulse, 
warmth of skin, furred tongue, etc. Sometimes it is gradual 
in its approach, advances slowly, and is associated with a 
debilitated state of system, and depressed rather than ex- 
cited vascular action. 

The urine is almost always scanty. In this, dropsies of 
whatever character, and from whatever cause, generally 
agree. It is not, however, always easy to determine exactly 
what constitutes scanty urine. The quantity of this secre- 
tion varies exceedingly in different persons, and in the same 
person under different circumstances, and within the limits 
of health. The average in twenty-four hours, in healthy 
individuals, may be stated at two or three pints. In dropsy 
it is often not more than a pint in the same time, and some- 
times is much less. In some rare cases of the disease, the 
urine remains undiminished, and is even increased, especially 
in the advanced stages. These are generally cases of de- 
bility, in which the serous portion of the blood finds a 
ready outlet through the relaxed vessels, whether of the 
kidneys or the serous or cellular tissue. 

The character of the urine is variable. In different 
cases, it is deep-brown, like beer, deep-red and lateritious, 
bloody, bilious, pale, light yellow or reddish, turbid, limpid, 
and quite healthy in appearance. 

Perspiration is generally deficient in dropsy. The bowels 



604 FUNCTIONAL DERANGEMENTS. 

are often costive, and sometimes very insusceptible to the 
action of purgative medicine, even of the most powerful 
kind. In some cases, the disease is complicated with 
chronic intestinal inflammation ; and then the patient is apt 
to be affected with diarrhoea. When this occurs without 
any amelioration of the dropsical symptoms, and especially 
in the advanced stages, or when dropsy supervenes during 
its prevalence, it is usually an unfavorable sign. 

Thirst is often one of the most prominent symptoms. It 
is not confined to the febrile form of the disease, but is 
often attendant upon the most feeble cases. 

The dropsical effusion may occupy any one of the serous 
cavities, or any portion of the cellular tissue, whether in 
the interior of the body, or beneath the skin. Gravitation, 
and consequently the position of the patient, have much 
effect in determining the position of the fluid, whether in 
the cavities or the cellular tissue. In the latter, the com- 
munication between the cells allows it to traverse the body 
with little difficulty. Hence, the swelling in anasarca is 
usually first observed, and is greatest, in the feet, ankles, 
and legs. Hence, in the cellular tissue of the lungs, the 
effused fluid generally occupies the lower portion, in conse- 
quence of the erect position of the patient. 

The disease is confined to no time of life : it is not un- 
frequent in infancy, is frequent in old age, and occurs at all 
intervening periods. It is, however, most common towards 
the decline of life. It occasionally undergoes a spontaneous 
cure. In such cases, the disappearance of the effusion is 
generally coincident with a great increase of some one or 
more of the secretions ; with the occurrence, for example, 
of a profuse diuresis, perspiration, or diarrhoea. Most of 
the disagreeable symptoms which occur during the progress 
of the complaint arise from the deranged functions of the 
various organs, consequent upon the pressure of the effused 
fluid. Its greatest danger is from the same source. 

Thus, respiration and the action of, the heart are embar- 
rassed from the pressure of liquid in the thorax ; and convul- 
sions, coma, palsy, and apoplexy occur from a similar cause 
within the cranium. (Edema of the glottis sometimes occa- 



DROPSY. 605 

sions the most serious consequences. The pressure of the 
distended fluid in the extremities not unfrequently occasions 
inflammation of the skin, terminating in gangrene and ulti- 
mate exhaustion. More frequently, however, the fatal 
result in dropsy is owing to the organic diseases in which it 
originates, as those of the liver, kidneys, and heart. 
Inflammations, such as pleurisy, bronchitis, and gastro- 
enteritis, not unfrequently occur in the advanced stages of 
the disease, and carry off the patient. In some instances, 
the effused fluid is entirely absorbed towards the close, and 
the patient dies exhausted, when the inexperienced might 
be indulging the hope of a favorable issue. 

Causes.— I consider as causes of dropsy those which pro- 
duce the several pathological conditions upon which the 
effusion depends. In the first place may be mentioned all 
those capable of inducing irritation or active congestion of 
the secreting tissue. Of these, one of the most common is 
exposure to cold, especially in a state of profuse perspira- 
tion. If, in this condition, the kidneys, from excess of 
excitement, or other cause, fail to perform the vicarious 
office that is thrown upon them, the irritation may be 
directed to the serous or cellular tissue, and dropsy result. 

Secondly, in the catalogue of causes may be ranked those 
which operate by relaxing and debilitating the tissues, and 
impoverishing the blood. These are frequently coincident. 
Among them are insufficient or unwholesome food, insuffi- 
cient clothing, habitual exposure to damp, cold, and impure 
air, impaired digestion, excessive secretion, great loss of 
blood, the intemperate use of alcoholic drinks, and long- 
continued and exhausting diseases, as irregular gout, 
scrofula, cancer, and scurvy. Dropsy is often the closing 
scene of such affections, and its occurrence may generally 
be regarded as a sure evidence of the breaking up of the 
constitution. It has been already stated that protracted 
intermittents may sometimes rank in this class of causes. 

Still another, and probably the most frequent set of 
causes, are those which obstruct, or in any way retard the 
return of the blood by the veins, and thus occasion venous 
congestion. These may act on portions of the venous sys- 



606 FUNCTIONAL DERANGEMENTS. 

tern, or on the whole. Simple debility may, to a certain 
extent, operate in this way, by retarding the returning 
current of blood from depending parts. It will be apt to 
do so if aided by posture. Long standing sometimes 
induces dropsical effusion in the lower extremities of feeble 
individuals. Pregnancy, uterine tumors, and enlarged 
ovaries, are thought to produce the same effect by pressure 
on the veins. Other diseases often prove a cause of dropsy, 
as scarlet fever, diseases of the liver, heart, kidneys, etc. 

Dropsy very generally yields readily to remedies. Within 
my own experience it has usually proved curable, when not 
dependent on tuberculous inflammation of the tissue affected, 
or upon organic disease of the viscera, as the heart, liver, 
and kidneys. Even in these cases, the dropsical symptoms 
will often disappear under appropriate treatment, and, if at 
the same time the organic affection be cured, will not return. 
Thus, permanent cures are not unfrequently effected of 
ascites dependent on chronic inflammation and engorgement 
of the liver ; and the same is true of renal dropsy in the 
earlier stage of the affection of the kidneys. Occasionally, 
even when the original disease remains, and marches 
steadily onward towards a fatal issue, the dropsy, after 
having been removed by treatment, does not again make its 
appearance. But much more frequently, under such cir- 
cumstances, it returns, and constitutes one of the greatest 
sources of distress to the patient towards the close of his 
life. Sometimes it may be removed, and will return several 
times, before it finally gets the mastery. 

Treatment. — In a disease so various in its origin and cha- 
racter, no one plan of treatment will be generally appli- 
cable. The remedies must necessarily be adapted to the 
particular circumstances of each case. Nevertheless, there 
are certain indications which should always be kept in view 
in the treatment. These are — 1. To correct, as far as 
practicable, the particular pathological condition upon which 
the effusion may immediately depend ; 2. To remove by 
absorption, or otherwise, the effused fluid ; 3. To remedy 
any disease, whether cardiac, hepatic, or renal, which may 
act as the remote cause of the dropsy; and, 4. To support 



DROPSY. 607 

the strength of the system. We shall often find that the 
same remedy will answer more than one of these objects; 
and that, where two or more remedies are required, they 
may very generally be given conjointly ; so that, in detail- 
ing the treatment, the several indications cannot be exactly 
followed without the inconvenience of ceaseless repetition. 
They will, however, be borne in mind in the following 
observations, as they always should be in practice. 

When there is reason to believe that the effusion is the 
result of an inflammatory or highly irritated condition of 
the exhaling tissue, and the general symptoms are those of 
active febrile excitement, or, even in the absence of fever, 
should the pulse be full and strong, blood-letting may some- 
times be employed with much benefit. It not only 
diminishes the secretory irritation, and thus checks the 
effusion, but disposes to the absorption of the effused fluid, 
according to the well-established principle, that the fulness 
of the blood-vessels and the activity of absorption are in an 
inverse ratio to each other. The amount taken must be 
regulated entirely by the condition of the system. The 
frequent repetition of small bleedings is, I think, highly 
objectionable ; for, though it may succeed in relieving the 
patient for a time, it will be apt to leave him afterwards 
still more disposed to the disease than at first. It is well 
known that frequent losses of blood have been the cause of 
dropsy by rendering the patient anemic. It is only, there- 
fore, in cases presenting a decided elevation in the grade of 
general action, that bleeding is admissible. In cases of the 
same general character as those above alluded to, with little 
or no increased activity of the circulation, it would be safer, 
as a general rule, to trust to the refrigerant diuretics and 
hydragogue cathartics without bleeding; this being employed 
only when clearly indicated. 

When, instead of irritation of the secreting tissues, we 
have relaxation or debility, with an impoverished condition 
of the blood — perhaps a scarcely less frequent condition 
than the former — a wholly different treatment is required. 
The indication now is to improve the condition of the blood, 
and give tone and increased contraction to the tissues. IFor 
39 



608 FUNCTIONAL DERANGEMENTS. 

this purpose, the preparations of iron, and those of Peru 
vian bark, are, upon the whole, the most efficient remedies. 
Carbonate of iron, conjoined with the sulphate of quinine, 
may be given three or four times a day ; and it will often 
be found convenient to unite in the same mass any diuretic 
or alterative medicines which the case may require, such as 
squill, digitalis, calomel, or the mercurial pill. The pre- 
parations of iron may be varied to meet the circumstances 
of the case. The tincture of chloride of iron, and the solu- 
tion of the iodide, would seem to be peculiarly appropriate ; 
as they add diuretic to their tonic and astringent proper- 
ties. The pure bitters are much used. Among the reme- 
dies occasionally employed is the decoction of pipsissewa, 
which is, at the same time, mildly tonic, astringent, and 
diuretic, and is admirably adapted to mild cases of this 
kind, requiring a gentle impression very long continued. 
Iceland moss has also been highly commended. No means 
will probably be found more efficacious in dropsy, originat- 
ing in low or bad states of the system, than the fever 
syrwp — it alone has succeeded in arresting the disease in 
my hands and in the hands of others. 

Dr. D. C. A. Moses, of Eldridge, Ala., writes : 

"You say nothing in your work of using your fever 
syrup in dropsy. Now if you never have used it in such 
cases, give it a trial : it will not disappoint you. The cases 
that I have used it in are such as are recognized by the 
profession generally as incurable, cases of long standing in 
the old and feeble, and which depend upon general atony of 
the whole system." A dessert-spoonful after each meal will 
usually be sufficient. It acts more efficiently when given 
in an effusion of some of the diuretics of the vegetable 
kingdom, as Indian arrow-root, watermelon seed, parsley- 
root, etc. I think the Indian arrow-root is the best. A 
wineglass of the strong infusion is a proper dose. 

To fulfil the same end of improving the condition of the 
blood, a diet composed chiefly of the most nutritious and 
digestible animal food should be recommended, and porter 
or ale may be given for drink. 

Conjointly with attention as above directed to the gene- 



DROPSY. 609 

ral condition of the system, whereby we may check the 
disposition to excessive exhalation, we should endeavor to 
fulfil the second indication, that, namely, of removing the 
effused liquid. This is done most effectually by promoting 
other secretions. We thus diminish the amount of circu- 
lating fluid, and proportionably favor absorption. At the 
same time, the tendency to exhalation is incidentally di- 
minished by the same means ; and if inflammatory excite- 
ment of the tissues exist, it is relieved by the depletion 
effected, and by a revulsive direction of excitement from 
the seat of disease to that of the stimulated function. 

Diuretics. — The symptoms of the disease strongly invite 
attention to the secretory function of the kidneys as that 
which especially demands stimulation. The urine is almost 
always scanty; and the progress of the effusion not unfre- 
quently bears a close and direct relation to its diminution. 
To increase the action of the kidneys would, therefore, 
seem to afford a probable chance of relieving the disease ; 
and experience has abundantly confirmed the deduction. 
No remedies prove more effective in the cure of dropsy 
than diuretics. When they can be brought to act freely, 
the disease is almost always moderated, if not removed. 
Of the diuretics, I have, within my own experience, found 
the bi-tartrate of potassa, or cream of tartar, most success- 
ful. Where no organic visceral disease or tuberculous depo- 
sition has been at the root of the malady, and when the 
strength of the patient has been sufficient to hold out under 
the continued use of the remedy, I have generally been 
able to cure dropsy by this diuretic, with or without adju- 
' vants, according to the apparent requisitions of the case. 
But, in order to produce the greatest effect, it must be 
given properly, and in sufficient quantity. Attention is fre- 
quently not paid to the comparative insolubility of the cream 
of tartar, and the patient takes only the liquid which may have 
been directed as the vehicle, leaving most of the medicine at 
the bottom of the vessel. Many practitioners content them- 
selves with directing half an ounce or an ounce to be taken 
at one dose, every day or every other day. The medicine 
thus given acts as a purge, and, being removed from the 



610 FUNCTIONAL DERANGEMENTS. 

bowels, is not absorbed, and consequently does not reach or 
affect the kidneys. A better plan is to direct a certain 
quantity to be added to a pint of water in a bottle, and the 
whole to be taken, in wineglassful doses, at certain inter- 
vals, in the course of twenty-four hours ; the caution being 
always strictly observed to shake the bottle thoroughly be- 
fore pouring out the dose, and then to swallow this quickly 
before the salt has had time to subside. The quantity 
must vary with the case ; and if, upon trial, that first em- 
ployed should make no impression, it should be gradually 
increased until it operates actively upon the kidneys. 
Half an ounce in the course of the day will, in some rare 
instances, be sufficient ; but much more frequently it will 
be necessary to increase to an ounce, an ounce and a half, or 
even two ounces, in the same period of time. If the 
patient should be much purged, it may be proper to admin- 
ister a little laudanum occasionally, so as to check the dis- 
charges, and give the remedy a direction to the kidneys. 
Should dyspeptic symptoms be induced, they may often be 
counteracted by employing as a vehicle for the salt, instead 
of water, an infusion of juniper berries, or wild carrot seed, 
which are at once gently stimulant and diuretic ; and some aro- 
matic, as cardamom, fennel, or ginger, may be added. When 
such additions are made, the infusion should be separately 
prepared, and strained before being used as a vehicle. Should 
the dyspeptic symptoms continue notwithstanding these 
means, the cream of tartar should be omitted for a time, 
and afterwards resumed if deemed advisable. I have given 
these somewhat minute directions from an experience of 
their usefulness, and the disadvantages which often accrue 
from their neglect. It has been stated above, that in all 
cases of dropsy not dependent on visceral disease, or tuber- 
cles, nor complicated with too great debility, a cure might 
be hoped for from this remedy. The only cases in which 
it is contra-indicated are those of great debility. If the 
strength of the patient, no matter what may be the form 
of the disease, should be observed to give way under the 
continued use of the salt ; and if the additional employment 
of sulphate of quinine, with a nutritious diet and malt 



DROPSY. 611 

liquors, or a little wine, should fail to counteract its debili- 
tating effects, it must be omitted altogether. 

Various other saline diuretics are employed with more or 
less success. Among them nitrate of potassa probably 
ranks next in efficacy to the bi-tartrate. Like that salt, it 
is especially indicated in inflammatory or febrile dropsy; 
but, being even more sedative in its general influence, and 
more apt to induce gastric irritation, it is applicable to a 
less extensive range of cases ; and should not be used when 
there are evidences of debility, or any suspicion of inflam- 
mation of stomach. As a remedy in dropsy, not less than 
two drachms should be given in twenty-four hours. This 
quantity should be dissolved in at least a pint of water, or 
of some mucilaginous or diuretic infusion, and a tablespoon- 
ful given every two hours. 

Squill is an active diuretic, much employed in this dis- 
ease. It is in fact among the remedies in which the pro- 
fession have the highest confidence. The oxymel, or 
syrup of squill, is the best form ; a teaspoonful or more 
may be giA^en every two hours ; or equal parts of the pow- 
der of squill and blue-mass may be made into pills, and one 
taken every three or four hours when the liver is torpid. 

Digitalis is another most valuable remedy in dropsy. 
Though it often fails in materially increasing a flow of urine, 
yet in other cases it operates with great power, producing 
and sustaining a copious diuresis, and completely eradicat- 
ing the complaint. It is best adapted to cases attended 
with debility, or in febrile cases, after bleeding and active 
purging have reduced the excitement. Any tendency which 
digitalis may have to purge should be counteracted by 
opium, which is also a useful adjuvant in some instances, by 
obviating the sedative effects of the remedy, without inter- 
fering with its diuretic action. The best mode of adminis- 
tering this diuretic is in substance or infusion. A table- 
spoonful of the officinal infusion, in which a drachm of the 
leaves is employed to nine fluidounces of water, though it 
is the dose usually directed, much exceeds in amount a 
grain of the powder, which is the usual dose in the latter 
form. It would be best to begin with only one-half the 



612 FUNCTIONAL DERANGEMENTS. 

quantity, repeated twice or thrice daily, and to increase ii 
gradually until some symptoms of its action are observed. 
The dose may in this way be augmented to ten or fifteen 
grains, or its equivalent. In whatever form or dose digi- 
talis is employed, its effects should be closely watched, and 
the appearance of a decided impression of any kind should 
be the signal for a suspension of the remedy or a diminu- 
tion of the dose. Great increase of the urinary secretion, 
reduction in the frequency and force of the pulse, or inter- 
missions in its beat, nausea and vomiting, purging, faintness, 
giddiness, and a tensive pain of the head, sometimes over 
one eye, are among the signs of the action of the medicine 
which demand its suspension. The tendency which digi- 
talis has to accumulate, and, after having been given for 
some time without apparent effect, to break forth suddenly 
into violent action, must also be borne in mind. 

Numerous other diuretics of greater or less power are 
occasionally employed, either as remedies in chief or as 
adjuvants. The spirits of nitre may be usefully added to 
other remedies. The infusion of juniper berries is much 
used as a vehicle and adjuvant, and will sometimes, unaided, 
remove moderate dropsical effusion. The compound spirit 
of juniper is a good addition to diuretic mixtures or drinks 
in cases of debility. Infusion of parsley-root, and the dif- 
ferent species of erigeron or flea-bane, are occasionally 
administered with benefit, though never solely relied on. 
Dandelion in decoction or extract is peculiarly adapted to 
cases of dropsy connected with chronic disease of the liver. 
Pipsissewa, in the same way, proves useful where a gentle 
tonic and astringent are indicated in conjunction with a 
diuretic. Various stimulating substances, with diuretic 
properties, may be employed in chronic cases, and others 
attended with great debility. Such are horse-radish, mus- 
tard, garlic, buchu, copaiba, oil of turpentine, and cantha- 
rides.* The two last-mentioned substances have been recom- 



* The following formula for a stimulating diuretic infusion was much 
employed by Dr. Parrish, and I have used it myself with much advan- 
tage in long standing dropsy with debility. Take of juniper berries, 



DROPSY. 613 

mended in great insensibility or paralysis of the kidneys, 
with a more or less complete suppression of urine. Besides 
those mentioned, a long list of substances might be enume- 
rated, which have enjoyed a greater or less degree of credit 
as diuretics in the* treatment of dropsy; but, having been 
mostly laid aside after experience of their inefficacy, they 
scarcely merit notice. It is, however, desirable to have at 
command, in a disease so frequently obstinate and protracted, 
numerous and diversified remedies, though of very unequal 
power. The caprices of the stomach, the prejudices and 
anxieties of the patient, and the frequent failure of even 
the most efficient remedies, render changes necessary ; and, 
without a long catalogue, we should be compelled to stop 
for want of sufficient material. Besides, diuretics are noto- 
riously uncertain, so that upon failure with one, it is neces- 
sary to resort to another ; and not unfrequently a persevering 
trial of the means within our reach is at length repaid by 
success when we have almost ceased to hope for it. Much 
may also be effected by the combination of these remedies. 
Great advantage has sometimes accrued from two or more 
diuretics mixed together, which had before severally failed. 
Numerous formulae of this kind have been proposed by 
different authors, which it would be useless to repeat. The 
combination of the diuretics with tonics has long been a 
favorite practice in cases of debility, and is no doubt highly 
advantageous in numerous instances. Thus, squill and the 
saline diuretics may be given in connection with the infusion, 
tincture, or extracts of the simple bitters, as gentian or 
quassia, with the preparations of cinchona, or with the salts 
of iron. The preparation of burnt copperas and elecampane, 
given under the head of dyspepsia, will be found admirably 
suited to many cases of dropsy connected with weakness and 
a bad state of the blood. 

Cathartics. — Scarcely less efficient than diuretics are the 
medicines belonging to the class of cathartics. They ope- 
rate upon the same principles, of promoting absorption by 

mustard seeds, ginger root, each, bruised, 1 ounce; horse-radish, parsley- 
root, each, bruised, 2 ounces; hard cider, 2 quarts. A wineglassful to be 
taken four times a day, and gradually increased. 



614 FUNCTIONAL DERANGEMENTS. 

diminishing the amount of fluid in the blood-vessels, and of 
calling off irritation from the morbidly secreting surfaces to 
the seat of their own action. Those should be preferred 
which produce copious serous exhalation from the bowels ; 
in other words, the hydragogue cathartics ; and even among 
these there is much room for choice. In febrile and inflam- 
matory cases, the saline cathartics should be employed, in 
consequence of their refrigerant properties. The best of 
these for the purpose are perhaps the bitartrate and tartrate 
of potassa and the tartrate of potassa and soda. These 
should be given, not in small and repeated doses, as when 
administered with a view to diuretic effect, but in large pur- 
gative doses, at distant intervals. When not of themselves 
sufficiently powerful, they should be combined with some 
one of the hydragogue vegetable cathartics, such as senna 
or jalap. A mixture of jalap and cream of tartar has long 
enjoyed a high credit in the treatment of dropsy. In 
chronic cases, when the bowels are torpid, and the whole 
system exhibits rather a want of due susceptibility to im- 
pressions than actual debility or prostration, recourse may 
be had to the drastic hydragogues. Scammony, black helle- 
bore, buckthorn, (rhamnus catharticus,) gamboge, croton oil, 
and elaterium, are those which enjoy the highest reputation. 
Of these, gamboge and elaterium are probably the most 
efficient. Dropsy not unfrequently yields to the judicious 
employment of these remedies alone. Gamboge, being apt 
to irritate the stomach, should generally be given in small 
doses, say from half a grain to two grains, repeated at 
intervals of one, two, or three hours, till it operates. Ad- 
vantage will also accrue from combining each dose with a 
drachm or two of cream of tartar. The effects of elaterium 
are sometimes surprisingly prompt and powerful. I have 
known great distention of the abdomen to yield to two 
doses of this medicine. In consequence of its violence, it 
must be administered with caution ; and, if symptoms of 
considerable irritation of the stomach and bowels should 
occur under its use, it should be at once suspended. 

There is a set of emeto-cathartic medicines, possessing 
diuretic properties, which have been much used in dropsy, 



DROPSY. 615 

and occasionally with good effect. Such are the broom, 
(scoparius,) hedge hyssop, (gratiola officinalis,) the inner 
bark of different species of sambucus or elder, cahinca, and 
the root of our indigenous apocynum cannabinum, or silk- 
weed. In relation to the dose and proper mode of adminis- 
tration of these, as well as of other medicines prescribed in 
this work, see Materia Medica and Dispensatory. 

The frequency of repetition of the cathartic must be 
regulated by the strength and susceptibility of the patient. 
When the constitution is vigorous, and the bowels not pe- 
culiarly sensitive, it may be given every day. In few cases 
can much permanent good be expected from it if repeated 
less frequently than twice or three times a week. The 
purgative, as in the case of the diuretic, may be combined 
with the bitter tonics, or chalybeates, when these medicines 
are indicated ; and, if the patient should be very feeble, 
advantage might accrue from the use of the purgative tinc- 
tures, as those of senna, jalap, and black hellebore, in con- 
nection with other preparations. 

Diaphoretics. — In some instances, diuretics will not act, 
and purgatives are contra-indicated, or have been tried with- 
out effect. Here diaphoretics may be resorted to, and will 
occasionally produce cures ; though, upon the whole, they 
must be admitted to be much less efficient than medicines 
of the two preceding classes. The best diaphoretic in 
dropsy is probably the officinal powder of ipecacuanha and 
opium. It is asserted that dropsy has been cured by large 
doses of opium alone ; but its efficacy is much increased in 
this combination. To do good, it must be used freely, and 
the patient kept for a considerable time under its influence, 
so as to sustain a copious and continued perspiration. In 
febrile cases, with a strong pulse, preference should be given 
to the antimonials and refrigerating diaphoretics, as citrate 
of potassa and acetate of ammonia, with which spirits of 
nitre may sometimes be combined. During the course of 
the treatment, the patient should be kept in bed. The effect 
of the diaphoretic may be much increased by external means. 
When the skin is hot and the circulation active, the warm 
bath should be used. But in other instances, the vapor 



616 FUNCTIONAL DERANGEMENTS. 

bath or dry hot air bath might be found more effective. 
The excessive sweating sometimes induced by temporary 
confinement in an apartment heated considerably above the 
temperature of the body would probably prove highly ser- 
viceable in some cases of dropsy. Even friction to the sur- 
face of the body is said to have effected cures. 

Emetics. — When the strength of the patient is sufficient 
to bear the exhausting effect of repeated emetics, it is pro- 
bable that they might be advantageously used, as they are 
well known powerfully to promote absorption. The anti- 
monial emetics were recommended by Sydenham in this 
disease. At present, however, neither these nor other 
medicines of the same class are much used in the treatment 
of dropsy. 

Mercury. — This is occasionally a very efficient remedy. 
Its power of increasing secretion and absorption would appear 
to render it applicable to dropsy in general ; while its anti- 
phlogistic action would render it especially useful in the 
advanced stages of those cases which have originated in 
inflammation, whether of the serous and cellular tissue, or 
of some important organ, as the liver or the heart. Hence, 
it is often most happily combined with other remedies, 
whether diuretic, diaphoretic, or purgative, increasing the 
powers of these remedies, at the same time that it exerts 
an independent influence of its own. But it is not admis- 
sible in purely anemic cases ; and in others should be given 
with caution, as it is unusually apt to salivate in dropsical 
cases. 

Mechanical Means. — When the measures above detailed 
prove inadequate to the removal of the effused liquid, and 
the distention becomes painfully inconvenient, recourse may 
be had to mechanical means of relief, such as punctures 
with a sharp lancet, and tapping. Great relief is obtained 
by these means ; and occasionally they seem to prepare the 
way for the efficient action of remedies which had failed 
before, probably by removing that compression, which may 
have cramped absorption. It has occurred to me repeatedly 
to see the kidneys brought in this way into efficient action, 
and the health of the patient restored when almost despaired 



DROPSY. GIT 

of. These measures, however, require to be used with cau- 
tion. The particular circumstances which justify or forbid 
their use will be most conveniently detailed under the dif- 
ferent forms of dropsy considered in relation to their posi- 
tion. Remarks upon the subject of blisters as depletory 
agents in dropsy will be best postponed to the same occa- 
sion. 

The Indian arrow-root (maranta) is often used as a 
domestic remedy in dropsy : the infusion made by steeping a 
handful of the root in a quart of hot water for an hour or two, 
and then strained and cooled, and a teacupful drank every 
two or three hours, has sometimes appeared to be the 
means of bringing away dropsical collections in an exceed- 
ingly short time. A distinguished medical friend informed 
me a short time since that very lately he and two other 
physicians had about exhausted their skill upon a case of 
ascites, without benefit to the patient, the kidneys remaining 
obstinately torpid ; when the patient, upon the suggestion 
of a neighbor, added the tea of the Indian arrow-root to 
the other means which he had been taking, and that, in the 
course of twenty-four hours, he passed several gallons of 
urine, and that the abdomen subsided almost as fully, and 
nearly as suddenly, as from the operation of tapping. 

Diet and Drink. — The free use of drinks was formerly 
denied to dropsical patients, under the impression that they 
served to supply additional stimulus to secretion, and at 
the same time additional material for effusion. This 
theoretical ground of exclusion still continues, with the 
superadded reason, afforded by recent investigations, that 
fulness of the blood-vessels is the greatest impediment to 
absorption. Nevertheless, experience has decided against 
these hypothetical deductions ; and nature, by the fre- 
quently urgent thirst which attends dropsy, and the 
extreme distress if it be denied gratification, throws the 
weight of her indications into the same scale. Practi- 
tioners now generally leave their patients to their own 
discretion in relation to the quantity of drink. A good 
rule is that the liquids should be taken cold, and in small 
quantities, frequently repeated, rather than in large draughts 



618 FUNCTIONAL DERANGEMENTS. 

at once. Thirst is thus as effectually relieved, while the 
stomach and blood-vessels are not so much overloaded. 
The choice of the drink must depend upon circumstances. 
Cold diuretic infusions sometimes satisfy the patient, and 
are better than cold water alone. In cases not of an 
inflammatory character, old cider sometimes answers an 
excellent purpose ; and when spirituous liquors are indi- 
cated on account of previous habits or debility, gin should 
be preferred. The compound infusion of horseradish, mus- 
tard, juniper, etc., in hard cider, is sometimes highly useful. 
No general rule can be given in relation to diet. The prac- 
titioner will in this respect be guided by the particular 
circumstances of each case, enjoining an antiphlogistic 
regimen in inflammatory cases, nutritious food in the anemic 
and debilitated, an easily digestible diet in those compli- 
cated with enfeebled digestion, and in all avoiding un- 
necessary interference with the habits and preferences of 
the patient. 

ANASARCA. 

This term signifies dropsy of the exterior cellular tissue. 
It is not usually extended to effusions into the cellular 
tissue of the interior organs considered separately, as, for 
instance, into the parenchyma of the lungs, or the sub- 
mucous structure. Nor is it customary to apply it to 
dropsical effusions of the exterior cellular tissue when of 
very small extent and quite local; these being designated 
by the term oedema. 

The first symptom of anasarca which attracts notice is 
usually a swelling of the feet and ankles, appearing towards 
evening, and diminishing, if not quite disappearing, before 
morning. It is distinguished from other swellings by pit- 
ting under pressure, that is, by retaining for a considerable 
time the indentations made by any compressing body. This 
tumefaction of the lower extremities does not by any means 
imply that the effusion of fluid has been confined to these 
parts. The cells of the cellular tissue communicate freely, 
so that fluid passes readily through them from one part of 
the body to another. In anasarca the effusion generally 



ANASARCA. 619 

takes place in various portions of the body, sometimes pro- 
bably throughout the whole exterior structure. During the 
day the fluid gravitates into the feet, which are the lowest 
part, and at night is again diffused over the frame in conse- 
quence of its horizontal position. Sometimes, however, the 
effusion actually takes place first in the feet and legs ; as in 
cases of debility, in which the want of energy in the circu- 
lation allows the blood to accumulate in the veins of the 
extremities, and thus to induce a condition highly favorable 
to the transudation of serum. In some instances, the 
tumefaction is first observed in the face, particularly about 
the eyes. This is apt to happen in febrile dropsy, in which 
the liquid is more quickly effused, and does not appear to 
travel so rapidly, and in certain conditions of diseased heart, 
in which the greatest stress of the circulation is on the upper 
part of the body. Another condition in which the effusion is 
likely to appear originally in the face, neck, or upper extre- 
mities, is that of obstruction in the veins which re-convey 
the blood from these parts, as in the descending vena cava. 
Cases of this kind have occurred in which the dropsy was 
confined to one arm. In certain rare instances of extremely 
rapid effusion, the dropsical swelling has shown itself simul- 
taneously over the whole surface of the frame. 

The swelling of the feet and ankles, in most instances, 
gradually increases, extends up the legs and thighs, en- 
croaches upon the abdominal and thoracic parietes, and at 
last reaches the head and upper extremities, so that the 
whole body becomes bloated, and sometimes to an enormous 
extent. The parts in which the cellular texture is loose, 
suffer tumefaction in the greatest degree. The lower 
extremities are often enormously increased in bulk, and the 
skin stretched, tense, and shining. Sometimes the cuticle 
rises in the form of blisters, or the skin itself gives way; 
an erysipelatous inflammation invades the integuments ; the 
cellular tissue sloughs ; and sores are formed, which 
become the outlets of great quantities of serous fluid, and 
thus afford much relief to the patient. Instances have 
occurred in which permanent cures have been effected in 
this way; but more frequently, though the patient may 



620 FUNCTIONAL DERANGEMENTS. 

obtain some ease to his oppression, the conjoined exhaustion 
and irritation are more than his enfeebled system can sup- 
port, and the case terminates fatally. 

Most frequently the anasarca when extensive is attended 
with effusion into the serous cavities, which very much 
increases the danger, and often proves the immediate cause 
of death. In some instances, however, the disease runs its 
whole course without such complication. Sometimes the 
anasarcous swelling suddenly disappears, and, by a sort of 
metastasis, is succeeded by dropsical effusion into the 
ventricles of the brain, or into the thoracic or abdominal 
cavity. 

This form of dropsy is liable to all the diversities of cha- 
racter which have been described under the head of dropsy 
in general. 

In relation to the causes and general treatment, there is 
nothing so peculiar as to require particular notice. The 
reader is, therefore, referred to the subject of dropsy in 
general. A few observations, however, in relation to the 
local treatment of the disease will be in place here. 
Bandaging the limbs in some cases proves of the greatest 
advantage by preventing inflammation and suppuration, 
while at the same time it promotes absorption. 

Small punctures may often be made with advantage in 
cases of great distention. The quantity of liquid which 
escapes even from a few of these minute wounds is some- 
times astonishing, and the relief to the patient indescribable. 
After puncturing, the limbs should be frequently bathed 
with an infusion of mullen leaves and oak bark, in order to 
prevent inflammation and ulceration from following, which 
sometimes become troublesome. 

HYDROCEPHALUS, OR DROPSY OF THE BRAIN. 

The term hydrocephalus is, in this work, considered as 
embracing only those cases of serous effusion within the 
cranium which are independent of inflammation. 

Symptoms, Course, etc. — The most obvious phenomenon 
in hydrocephalic patients is the enlarged or gradually 
enlarging head. The expansion takes place usually in all 



DROPSY OF THE BRAIN. 621 

parts of the bony case of the brain except the base. As 
the face is in general not larger than usual in health, the 
forehead and sides of the cranium are made to project very 
much, and give to the child a peculiar aspect. In some 
instances, it is said that the face undergoes a corresponding 
development, and the whole head appears gigantic. The 
enlargement is sometimes irregular, affecting especially the 
forehead or the parietal region, and being much greater on 
one side than the other, so as to occasion great deformity. 
The fontanels expand very much, the sutures not unfre- 
quent ly open, and the bones of the cranium are seen in some 
extreme cases to be almost floating upon a surface of liquid. 
Fluctuation can be perceived between them ; and the inter- 
osseous spaces are either at the level of the surface, or 
project somewhat above it. It is said that, in some cases 
in which the collection of water is very great, the head 
appears somewhat translucent if placed between the eye 
and the light. 

After a length of time, which is exceedingly variable, if 
the patient survive, the interosseous spaces are gradually 
converted into bone, and the cranium becomes entire ; but 
it is no uncommon event for the fontanels to remain open 
in hydrocephalic patients for many years. After the com- 
plete ossification of the cranium, the head ceases to expand ; 
and, unless there should also be a cessation of the gradual 
increase of the effusion, severe symptoms soon make their 
appearance. While the bones yield readily to the accumu- 
lating liquid, and no great pressure is exerted upon the 
brain, it not unfrequently happens that the general symp- 
toms of the disease are not striking. When the disease 
attacks children whose fontanels have closed, the expanding 
force is sometimes sufficient to reopen them, and this event 
has happened as late as the eighth or ninth year. 

The size which the cranium is capable of attaining in this 
complaint is enormous. Thus, the circumference of the 
head in a child two years old, under the notice of Willan, 
was twenty-nine inches ; and of another of fourteen months, 
seen by Barthez and RAlliet, nearly twenty-three inches. 
In general, however, the size is much less, and it varies by 



622 FUNCTIONAL DERANGEMENTS. 

ever}" gradation, from the least visible expansion to the 
largest dimensions mentioned. 

The duration of the disease is uncertain. Most of those 
affected die in infancy. Some live on for many years, and 
now and then one to adult age, and, it is said, even to 
old age. 

Causes. — The same condition of the blood and of the ex- 
treme vessels which sometimes induces dropsy in the cellular 
tissue and the serous cavities may operate in the brain so 
as to occasion hydrocephalus, especially when, from a want 
of union between the bones of the cranium, little resistance 
is offered to the accumulation. 

Treatment. — When the child exhibits signs of scrofulous 
diathesis, or is anemic, the chalybeates, preparations of 
iodine, and decoction of pipsissewa, may be used. Revul- 
sion to the scalp, by means of blisters, croton oil, oil of 
turpentine, ipecacuanha in the form of liniment, or other 
irritant substances, has also been recommended. Care must 
be taken, in the use of the remedies, not to exhaust the 
strength of the patient. Of the diuretics, squill, spirit of 
nitric ether, bitartrate of potassa, and perhaps digitalis, may 
be used, though the last always with caution. Cream of 
tartar, combined, when the patient is somewhat vigorous, 
with jalap, would be the best cathartic. The fever syrup, 
given as directed under the head of general treatment of 
dropsy, has done more in our hands than any other means : 
cases apparently hopeless have yielded to this treatment. 

HYDROTHORAX, OR DROPSY OF THE CHEST. 

Though generally applied at present exclusively to drop- 
sical collections in the pleura, the term hydrothorax may 
be appropriately extended to any case of serous effusion 
within the thoracic cavity ; and in this enlarged acceptation 
I shall here employ it. There are three positions which 
may be severally or jointly occupied by this affection : the 
cavity of the pleura, that of the pericardium, and the pul- 
monary parenchyma. 

Pleural Drops?/. — More or less serous fluid is very often 
found in the pleural cavities after death, without having 



DROPSY OF THE CHEST. 623 

given rise, during life, to any disturbance of health. This 
may be the result of effusion occurring like copious sweats, 
in the dying state, or may be purely cadaveric, or may have 
existed unnoticed during life. To constitute dropsy, the 
effusion must be so considerable as to derange in some de- 
gree the healthy functions. When it exists to this extent, 
it produces more or less difficulty of breathing, which is 
increased by any bodily exertion, especially running, or 
ascending heights, and is greater in the horizontal than in 
the erect position. The dyspnoea is slight at first, but in- 
creases as the disease advances, and often becomes excessive 
before its close ; bearing a close relation to the amount of 
the effused liquid. The patient lies preferably on the side 
most affected, generally with his head and shoulders ele- 
vated ; and in the advanced stages is often unable to lie 
down at all, maintaining, day and night, continuously the 
sitting posture. The pressure upon the lungs impedes the 
pulmonary circulation ; and, as a consequence, the face has 
often a livid or purplish hue, and the lips are sometimes 
almost black in bad cases. This disease is often associated 
from the commencement with anasarca ; and, when this is 
not the case, oedema of the face in the morning, and of the 
feet and ankles towards night, is very apt to make its ap- 
pearance before the close. 

The causes of pleural dropsy do not differ from those of 
the general disease. It originates most frequently in or- 
ganic affections of the heart, the great blood-vessels, or the 
lungs, and is apt to be associated with tubercles in their 
earlier stages. As in all other forms of dropsy, the effusion 
may depend upon inflammation of the secreting membrane. 
Some authors consider the serous effusion arising from this 
cause as distinct from dropsy, but fail to assign a good rea- 
son for the distinction. When the effusion is simply serous, 
it must be considered dropsical, whatever may be its origin. 
The cases considered as idiopathic hydrothorax are probably, 
in most instances, the result of a high irritation of the 
membrane, which has not reached the point of inflammation, 
simply because the blood-vessels have relieved themselves 
40 



624 FUNCTIONAL DERANGEMENTS. 

by effusion. Sometimes the disease results from a sudden 
transfer of the morbid process, whatever it is, from the cel- 
lular tissue to the pleura; the anasarca disappearing as the 
hydrothorax occurs. 

In relation to the treatment, little need be added to what 
was said under general dropsy. When there is reason to 
believe that the effusion depends upon an inflammatory con- 
dition of the pleura, very great advantage may be expected 
from occasional cupping, and repeated and long-continued 
blistering. Of the internal remedies, perhaps most reliance 
is to be placed upon a combination of squill and calomel, 
the latter being carried to a slight ptyalism. 

Pericardial Dropsy — Hydropericardium — Dropsy of the 
Heart. — A certain quantity of serum in the pericardium 
does not appear to be incompatible with health ; at least, it 
is frequently found after death, without any previous symp- 
toms that could have led to a suspicion of its existence. 
As in the pleura, the probability is that the effusion is partly 
an attendant on the last agony, or merely cadaveric ; but it 
can scarcely be doubted that, in many cases, it has existed 
during life. How much may be considered as constituting 
disease cannot be exactly determined ; for the effects from 
the same quantity vary greatly with the rapidity of its ac- 
cumulation. A small portion, effused quickly, will embarrass 
the heart more than a much larger quantity collected slowly, 
so as to allow that organ to be gradually accustomed to its 
presence. Corvisart considered six or seven ounces as, on 
the average, sufficient to indicate a morbid state, and it is 
probable that less will sometimes interfere with the circula- 
tion and respiration. 

As in pleural dropsy, there is much difficulty in distin- 
guishing the symptoms produced by the effusion from those 
of coexisting diseases, especially of the heart ; and not un- 
frequently the same symptoms have their origin in both 
affections. 

This form of dropsy, when dependent on inflammatory 
irritation of the pericardium, or on a general dropsical dia- 
thesis, is susceptible of cure ; but too frequently it is quite 



DROPSY OF THE CHEST. 625 

incur able 7 in consequence of the incurable nature of its 
cause ; and it is generally of this character when very 
abundant. 

In relation to the causes of pericardial dropsy, it is 
scarcely necessary to add any thing to what has been already 
stated. It is most frequently the result of disease of the 
heart, great blood-vessels, or lungs. It has been traced also 
to a tuberculated condition of the pericardium. As the 
other kinds of dropsy, it may depend upon simple irritation 
of the membrane, or upon those general conditions which 
give rise to dropsy everywhere. 

Nor is there any thing peculiar in the treatment. 

Pulmonary (Edema. — Dropsy of the Lungs. — This name is 
applied to serous effusion into the parenchyma, or substance 
of the lungs. When considerable, it occasions great dysp- 
noea, hurried breathing, and frequently cough, with the 
copious discharge of a thin, colorless, frothy liquid. There 
is more or less dulness upon percussion, which is most evi- 
dent when the two lungs are unequally or one exclusively 
affected, the contrast between the two rendering the want 
of resonance in the dropsical lung more obvious. The re- 
spiratory murmur is diminished, but is not altogether lost, 
unless in parts of the lungs in bad cases. Both the dulness 
on percussion, and the indistinctness of the respiratory 
murmur, are most decided in the lower and back portion of 
the chest. There is a subcrepitant rale during inspiration, 
resembling that of pneumonia, but not so fine, and attended 
with the mucous rale, indicative of liquid in some of the 
larger bronchia. The affection is very frequently accom- 
panied by oedema of the face or extremities, and even gene- 
ral anasarca. 

The causes of oedema of the lungs are the same as those 
of dropsy in general, and need not be repeated here. It 
not unfrequently accompanies pleural dropsy ; and is apt to 
be found in old cases of disease of the heart, with anemic 
symptoms. There is nothing special in the treatment. If 
curable, it will yield to the diuretics, purgatives, etc., em- 
ployed in general dropsy. 



\ 



626 FUNCTIONAL DERANGEMENTS. 



ABDOMINAL DROPSY. 

The term ascites is now confined to dropsy of the peri- 
toneum. Serous cysts within the abdomen often produce 
great distention, and imitate ascites in some of its most 
prominent symptoms ; but they constitute a different affec- 
tion, having a different origin, and requiring a different 
treatment. They are usually designated as encysted dropsy, 
or, when connected with the ovaries, ovarian dropsy. 
Though not strictly belonging to the present category in a 
correct nosological arrangement, they will be most conve- 
niently considered in this place, from their apparently close 
relation to ascites. 

ASCITES. 

This is a frequent form of dropsy ; but my own observa- 
tion does not accord with that of the authors who make it 
the most frequent. It commences usually with an uneasy 
feeling of fulness in the abdomen, to which the attention of 
the patient is first called by finding his clothes too tight. 
The distention is first observable in the lower portion of the 
abdomen when the patient is in the erect position, and dis- 
appears when he lies down. But it gradually extends, and, 
when the complaint is at its height, the whole belly is uni- 
formly, and often very greatly swollen. The character of 
the tumefaction is known by the wave-like impulse imparted 
to the hand placed in contact with the side of the abdomen, 
when slight percussion is made with the fingers of the other 
hand upon the opposite side. The sensation produced is 
quite distinctive, and can scarcely be mistaken. 

The affections with which ascites might possibly be con- 
founded, are pregnancy, tympanites, an enormously dis- 
tended bladder, and the various forms of encysted dropsy. 

In ordinary cases of pregnancy there can be no diffi- 
culty. But when the uterus, as sometimes happens, is 
greatly distended with serous fluid, so as to impart a de- 
cided sense of fluctuation to the hand, or when pregnancy 
is complicated with ascites, the diagnosis is occasionally 
embarrassing. In pregnancy, however, the abdomen re- 




I/- 

18. 



19- 



A VIEW OF THE FACIAL NERVE. 



The Portio Dura or Facial Nerve 

escaping from the Styio- Mastoid 

Foramen. The Parotid Gland 

has been removed in order to 

show the Nerve more clearly. 

Its Posterior Auricular Branch. 

The Stylo-Hyoid Branch. 

The Pes Anserinus. 

Temporal Branches of the Facial 

Nerve. 

Malar Branches. 

Cervico-Facial Branches. 

Supra-Orbital Nerve. 
Sub-Cutaneous Malae, a branch of 

the Superior Maxillary Nerve. 

The Infra-Orbital Nerve. 

Terminal Branches of the Inferior 

Dental Nerve. 

Nervus Auricularis of the Cervical 

Plexus. 

The Superficialis Colli Nerve. 
The Plexus formed between the 
Superficialis Colli and the branches 
of the Faciai. 

The Occipalis Minor Branch of 
the Cervical Plexus. 
Descending branches of the Cer- 
vical Plexus. 
The Phrenic Nerve. 
The Nervus Accessorius of the 
Eighth Pair. 

The Great or Posterior Occipital 
Nerve. 




i. The great Blood- Vessels of the 
Heart. 

2. The Lungs of each side. 

3. The Heart. 

4. The Diaphragm. 

5. Under surface of the Liver. 

6. The Gall Bladder. 

7. Union of the Cystic and Hepatic 
Ducts to form the Ductus Choledo- 
chus. 

8. Anterior Face of the Stomach. 

9. The Gastro-Hepatic, or lesser 
Omentum. A Female Catheter 
has been passed through the For- 
amen of Winslow, and is seen 
through the Omentum. 

10. Gastro-Colic, or greater Omentum, 
cut off, so as to show the small In- 
testines. 

11. The Transverse Colon, pushed 
slightly downward. 

12. Its ascending portion, also pushed 
down. 

13. Small Intestines. 

14. The Sigmoid Flexure. 

15. The Appendicula Vermiforrnis. 



A VIEW OF THE VISCERA. 



ASCITES. 627 

mains more prominent when the patient is on her back, and 
does not so much bulge out latterly. 

Nothing is easier than the diagnosis between dropsy and 
tympanites. The absence of fluctuation, and the universal 
resonance in the latter affection, are sufficient distinctions. 
But the two affections are often complicated, and in such a 
manner as to render it somewhat difficult to decide how 
much of the distention is tympanitic, and how much drop- 
sical. The relative degree of fluctuation and of resonance 
on percussion must decide the question as to the relative 
amount of liquid and air present. Fluctuation and flatness 
on percussion must be sought for in the most depending 
parts of the abdomen. 

In relation to the distended bladder, the history of the 
affection, its attendant symptoms, the regular outline of the 
dulness in the lower part of the abdomen, and the pain on 
pressure, would sufficiently distinguish the distended blad- 
der ; and, if there should still be doubt, it would be at once 
removed by the introduction of the catheter. 

The diagnosis between ascites and encysted dropsy will 
be given, when the latter affection is especially considered. 

Causes. — Both in relation to the pathological condition 
and causes of ascites, there is little to be added to what 
has been said on general dropsy. It is most commonly con- 
nected with disease of the liver or other abdominal viscera. 

Prognosis. — Ascites, when dependent upon the same 
causes as external dropsy, and associated with it, is very 
often cured. When it exists exclusively, it is apt to be 
much more obstinate, because connected with affections of 
an intractable or incurable character. But even in this 
form, those writers go too far who affirm that it rarely gets 
well. It is true that, in very many cases, it is altogether 
unmanageable, and ends sooner or later in death. It is true 
also, that even in cases in which the fluid may be removed 
by general treatment, it often returns, because the root of the 
disorder has not been reached. But, nevertheless, instances 
of recovery are not uncommon. They have repeatedly 
occurred within my own observation. This result may be 
looked for with some confidence when the effusion depends 



628 FUNCTIONAL DERANGEMENTS. 

upon simple peritoneal irritation from checked perspiration, 
repelled eruptions, etc.; and it not unfrequently happens in 
cases of tumefaction of the liver, from simple chronic in- 
flammation. Occasionally a spontaneous cure takes place 
by the r establishment, of the urinary secretion, or the 
occurrence of copious discharges from the skin or bowels. 

Treatment. — This is to be conducted according to the plan 
already fully detailed under general dropsy. Perhaps the 
most efficient remedies for the removal of the fluid are the 
hydragogue cathartics. Elaterium will sometimes act like 
a charm. But the debilitating effects of purgatives cannot 
always be borne, and it is necessary to resort to the diure- 
tics. Bitartrate of potassa often answers an admirable 
purpose. But whatever remedy is employed for the evac- 
uation of the serum, it is very often essential to conjoin 
with it the use of mercury. This is especially the case 
when the disease originates in chronic inflammation of the 
liver. The mercurial should be cautiously employed, so as 
but slightly to affect the gums, and should be persevered in 
for a long time, occasionally for several months. Some 
recommend, under similar circumstances, the use of iodide 
of potassium ; but this should never be relied on to the ex- 
clusion of mercury. Frictions with iodine ointment daily, 
or twice a day, over the region of the tumefied liver, should 
always be employed. 

Well-regulated compression of the abdomen by means of 
bandages has sometimes been of undoubted advantage. It 
is applicable to the earlier stages, before the distention has 
become so great as much to embarrass respiration. 

Tapping has been much employed, and various opinions 
have been expressed of its advantages. While some allow 
it only as a last resort, merely to obtain temporary relief, 
when all ordinary means have failed, others have recom- 
mended it as a remedy, capable, in some instances, of 
effecting cures. There can be no doubt that permanent 
cures have in some rare cases followed this operation ; and 
the opinion held by some, that, by removing pressure from 
the kidneys, it favors the action of diuretics, is probably 
not entirely without foundation. Nevertheless, it very gene- 



ASCITES. 629 

rally fails to do more than yield temporary relief; and the 
liquid accumulates again, often even more rapidly than be- 
fore, so as to render a frequent resort to the operation 
necessary. The quantity of serum which has been drawn 
off, and the number of times that tapping has been repeated 
in some instances, are astonishing. In a case of Stoerck's, 
twelve and a half gallons were evacuated at one operation ; 
Dr. Beall, of Missouri, records a case in which the opera- 
tion was performed ninety-six times in the course of a few 
years, and the whole amount drawn off was two hundred 
and seventy-five gallons and a half; and a case was reported 
by M. Lecanu to the Paris Royal Academy of Medicine, 
in which a woman was tapped eight hundred and sixty-six 
times, and ultimately recovered under compression of the 
abdomen. (Dunglison's Notes to Cyc. of Pract. Med.) 
Nor is paracentesis without danger. Leaving out of the 
question the instances in which the intestines or uterus 
have been wounded, and an artery divided, there is occa- 
sional danger from inflammation of the peritoneum, and the 
operation has repeatedly been followed by fatal effects. 
It is probable, moreover, that, in most of those cases in 
which cures have followed it, the same result might have 
been obtained from other treatment. On the whole, it 
seems most advisable to resort to paracentesis only when it 
becomes necessary, from the failure of purgatives, diuretics, 
compression, etc., to afford the patient relief from great op- 
pression, or to postpone for a period the fatal termination. 
In the performance of the operation, it is highly important, 
as the fluid escapes, to make compression of the abdomen 
by means of a bandage, so as to supply artificially the pres- 
sure of the viscera to which the patient has been so long 
habituated, and the sudden withdrawing of which has re- 
peatedly proved fatal, when this precaution has been neg- 
lected. 

I have no individual experience with this remedy, having 
never had occasion to perform it, as other means hav r e 
always been successful in removing the water, even when 
the case has been connected with other incurable diseases. 



630 FUNCTIONAL DERANGEMENTS. 

ENCYSTED DROPSY. 

In this form of dropsy the fluid is not contained in the 
general peritoneal cavity, as in ascites, but is confined in a 
separate apartment, and usually originates in what is known 
as hydatids. These may be attached to any of the abdom- 
inal or pelvic viscera, as the liver, pancreas, ovaries, fallo- 
pian tubes, etc., but most commonly they originate on or 
are attached to the ovaries, and hence are known as ovarian 
dropsy. In the early stage of this disease it is easily rec- 
ognized, as the enlargement will present an isolated condi- 
tion, and is felt through the walls of the abdomen as a 
distinct tumor, and in this stage may be recognized by not 
presenting the hardness to the touch or the sensibility 
which would characterize a phlegmonous tumor in the 
same locality. In an advanced stage, when the cyst has 
become so large as to pretty well occupy the whole of the 
abdominal cavity, it will not be so easily distinguished from 
ascites; but even then we may come to a pretty certain 
conclusion by the history of the case, and from the fact 
that in changing the position of the body the tumor does 
not so readily obey the laws of gravitation. But a diagno- 
sis is of no importance, as the disease should be treated 
upon general principles. Encysted cases, however, are not 
usually so amenable to treatment as is general abdominal 
dropsy; but still, even in these cases, efforts for relief 
should not be abandoned, as they do sometimes succeed. 



NEURALGIA. 631 



CHAPTER V. 

FUNCTIONAL DERANGEMENTS CONNECTED WITH THE URINARY 

ORGANS. 

Under this title are here included all the diseases of the 
urinary organs not consisting in organic derangement; con- 
sequently all their states of irritation or depression, whether 
merely nervous, or involving also the blood-vessels, and all 
the deviations from the healthy performance of their func- 
tions, whether secretory or excretory. These diseases may 
he conveniently arranged in two divisions, the first includ- 
ing affections purely nervous, the second disorders of secre- 
tion and excretion. 

NERVOUS AFFECTIONS NEURALGIA. 

The kidneys, bladder, and urinary passages in general 
are liable to attacks of pure neuralgia. These are charac- 
terized by pain, generally very acute, without any evidence 
whatever of inflammation or considerable vascular excite- 
ment, and without spasm. Perhaps no disease to which 
the human system is subject gives rise to more acute suf- 
fering than sometimes arises from nervous affections of the 
ureters extending to the testicles. The author has repeat- 
edly seen strong men weep like children under this afflic- 
tion; and in no disease will remedies be followed by more 
satisfactory effects than in the application of hot fomenta- 
tions to the parts affected in such cases. 

Such cases are not usually attended with material de- 
rangement of the urine, with pain or other irregularity 
in its evacuation, or with fever; and, if nausea and 
vomiting occur, it is merely in consequence of the close 



032 FUNCTIONAL DERANGEMENTS. 

sympathetic connection between the stomach and urinary 
apparatus. 

The causes are the same as of neuralgia elsewhere; occa- 
sionally it appears to be connected with hysteria. 

The treatment is the same as that of neuralgia seated 
elsewhere, and is given under the general heading of that 
disease. It may not be improper, however, to mention here 
that, when regularly intermittent, it will generally yield to 
anodynes during the paroxysms, and large doses of quinine 
in the intervals. 

CALCULOUS NEPHRALGIA SPASM OF THE URETERS NEPHRITIC 

COLIC. 

This is one of the most painful affections to which the 
human frame is incident. It depends upon the passage 
through the ureter of a calculus or other solid body, coming 
on when this enters the duct upon leaving the pelvis of the 
kidney, and rarely ceasing entirely until it has discharged 
into the bladder. The pain is probably excited immediately, 
either by the roughness of the calculus wounding the mucous 
membrane, or by its size producing distention. There is 
reason to believe that concrete organic matter, as blood or 
fibrin, may sometimes give rise to the affection. 

During an ordinary attack of gravel, or in the midst of 
apparent health, a severe pain is suddenly felt in the loins, 
shooting to the groin, testicle, or thigh, and often extend- 
ing into the abdomen, where it closely imitates colic. The 
space between the ileum and umbilicus is sometimes acutely 
sensible to pressure. The pain occurs usually in irregular 
and excruciating paroxysms, with intervals of comparative 
ease, bearing a close resemblance to spasm. Should it still 
remain in the bladder, or be caught and fixed in the urethra, 
the aid of the surgeon should be called in. 

This affection is different from nephritis, and requires a 
different treatment. The pain comes on before there has 
been time for the development of inflammation, and does 
not in any degree necessarily depend on that cause. Should 
the calculus, however, be detained long, inflammation will 
ensue : and then the two affections will coexist. The total 



SPASM OF THE URETERS. 633 

absence of fever, while that affection always attends acute 
nephritis, is generally sufficiently diagnostic of the nature 
of the complaint. 

Treatment. — The prominent indications are to relieve the 
suffering of the patient during the passage of the calculus, 
and to render this passage as speedy as possible. If the 
pain should not be very severe, the bowels should first be 
evacuated by a full dose of castor oil or other mild yet quick 
cathartic, so as to prevent any injurious irritation from fecu- 
lent accumulation. The cathartic may be aided, if it do not 
operate speedily, by a purgative enema; and, in cases at- 
tended with much irritability of stomach, the latter remedy 
may be employed to the exclusion of the former. After 
the bowels have been emptied, opiates should be given 
promptly and freely. When the pain is extremely violent, 
it is best not to wait for the action of cathartic medicine, 
but immediately to administer opium, while an attempt is 
made at the same time to evacuate the lower bowels by an 
enema containing a portion of oil of turpentine, with other 
milder ingredients. One or two grains of opium, or an 
equivalent dose of laudanum, black-drop, or one of the salts 
of morphia, should be given at first, and repeated at inter- 
vals of half an hour, hour, or two hours, according to the 
urgency of the pain, until this is somewhat alleviated, or 
the patient exhibits signs of narcotic influence. Should the 
stomach be irritable, the opiate may be administered with 
as powerful and prompt effect by the rectum, in double or 
triple the dose. From forty to sixty or even eighty drops 
of laudanum may thus be given in a wineglassful of thin 
starch, and repeated if necessary. If relief should not be 
afforded by these measures, the patient should be immersed 
in a warm bath, and kept in it for an hour or more if he 
bear it well. Indeed, it will generally be proper to have 
the bath prepared immediately, and used as soon as ready, 
while the other measures are in progress. Hot fomentations 
to the abdomen and loins may also be employed. 



634 FUNCTIONAL DERANGEMENTS. 



SPASM OF THE BLADDER. 

This is marked by violent pain, with a feeling of con- 
striction in the region of the bladder, which is sometimes 
contracted into a hard ball. Sometimes the contraction is 
so great and so permanent as to close the orifice of the 
ureters, and thus to occasion an apparent suppression of 
urine, which accumulates in the pelvis of the kidney, and 
leads to serious irritation of that organ. During the par- 
oxysm, the patient is sometimes affected with cold perspira- 
tion, paleness of surface, feeble pulse, and great restlessness 
and general distress. Often, however, the spasm is less 
violent and continuous, and the affection altogether much 
more moderate. From cystitis it is distinguished by the 
absence of fever, the want of pain on pressure, and its par- 
oxysmal character. 

Spasm of the bladder may proceed from stone, from acrid 
urine or other morbid renal secretion, from similar morbid 
secretions of the bladder itself in a state of organic disease, 
from the direct irritation of cantharides or other acrid 
diuretics taken into the stomach, from sympathetic irritation 
occasioned by ascarides in the rectum, from gout and hyste- 
ria, and finally from exposure to severe cold. When con- 
nected with long-continued organic affections of the kidneys 
or bladder in old people, it is sometimes the immediate 
cause of death by its shock upon the already exhausted 
nervous system. It is almost always susceptible of relief 
when idiopathic, and often ceases without the intervention 
of remedies. 

Treatment. — It is obvious that, when it is dependent on 
any discoverable source of irritation, this must be removed 
if possible. So far as regards the spasm itself, it is most 
effectively treated with opiates, especially in the form of 
enema, and very freely administered. Warm fomentations 
or the warm bath should at the same time be used. 

IRRITABLE BLADDER. 

By this term is meant an increased susceptibility, which 
renders the bladder morbidly and even painfully impressible 



PARALYSIS OF THE BLADDER. 635 

• 

by healthy urine or other natural and wholesome stimulus. 
This is often a purely nervous complaint, connected some- 
times with debility, sometimes with hysteria, and sometimes 
with a disordered condition of the brain, spinal marrow, or 
other nervous centre. It may be merely the first step 
towards inflammation of the bladder, and dependent on the 
various causes of that affection, acting in a less degree, or 
upon a less impressible system. (See Cystitis.) It is in 
general distinguishable from other affections by the healthy 
state of the urine, and by the absence of fever, of pain or 
tenderness in the region of the bladder, of the symptoms 
of stone, of stricture of the urethra, and of other signs in- 
dicative of organic renal or cystic disease. 

In the treatment of this idiopathic irritability, it is. neces- 
sary to consult the state of the system. If the patient is 
robust and plethoric, a dose of sulphate of magnesia, the 
warm bath, and an antiphlogistic regimen, will generally 
remove the complaint, and probably prevent the develop- 
ment of acute or chronic cystisis. Should the affection be 
painful, an anodyne enema may be administered. The 
patient should drink freely of mucilages, and the bowels 
should be kept loose, though all aloetic or stimulating 
cathartics should be avoided, and only the mildest laxatives 
employed. If the complaint be connected with debility, 
mild tonics and astringents should be used, such as uva 
ursi, pipsissewa, the simple bitters, the mineral acids, and 
the tincture of the chloride or the solution of the iodide of 
iron. Occasionally, when there is no pain, the more stimu- 
lating diuretics may be advisable, as the balsams, the 
turpentines, wild carrot, etc. The occasional use of local 
or general cold bathing, or the shower-bath, will also be 
advantageous. In hysterical affections, the antispasmodics 
may be conjoined with other remedies. Counter-irritation 
to the spine is also useful. 

PARALYSIS OR DEBILITY OF THE BLADDER. 

It often happens that, from want of due sensibility, or 
of muscular power, the bladder is unable to perform its 
office, or performs it but imperfectly. The symptoms vary 



636 FUNCTIONAL DERANGEMENTS. 

• 

with the part affected. When the neck of the bladder Is 
exclusively concerned, incontinence of urine is the conse- 
quence. If the bladder in general is affected, we have 
retention of urine, in consequence of insensibility to its 
presence, or inability to contract upon it. These conditions 
may exist in very different degrees, from mere nocturnal 
incontinence on the one hand, or slight difficulty of micturi- 
tion on the other, up to a constant flow of urine from 
inability to retain it, or a degree of retention sufficient 
greatly to distend the bladder, and endanger life from injury 
of that organ. There is seldom, however, complete reten- 
tion, the urine escaping in small portions by an involuntary 
stillicidium, especially when the patient sleeps, and thus 
giving rise to very great inconvenience. 

This partial or complete palsy may arise from a direct 
diminution of nervous energy, as in the gradual decay of 
strength incident to old age, and in cases of spinal and 
cerebral disease, producing palsy elsewhere as well as in 
the bladder ; or it may come on as a result of excessive 
or long-continued excitement, as from venereal excesses, or 
those organic diseases of the kidneys, prostate, etc., which 
sustain an incessant irritation of the bladder until they 
exhaust at once its sensibility and power. In low fevers, 
this condition of the bladder is a not unfrequent concomi- 
tant of the general diminution of nervous energy. It 
occurs also occasionally in hysteria, as a consequence of the 
irregular distribution of nervous influence characteristic of 
that complaint. 

When the affection depends upon cerebral or spinal lesion, 
or upon organic complaints of the urinary apparatus, it 
must be remedied, if at all, by addressing our measures to 
the real seat of disease. When the consequence of ex- 
cessive indulgences, it can be relieved only by a change of 
habits. In cases associated with general debility, the vege- 
table tonics, the chalybeates, and the mineral acids, with 
the cold bath, are the appropriate remedies. Stimulation 
of the bladder by medicines having a tendency to the pelvic 
viscera, such as oil of turpentine and cantharides, or by 
electricity, will sometimes be of great utility in cases in 



STRANGURY. 637 

which the affection is purely local. Hysterical cases must 
be treated by the means applicable to the same kind of dis- 
order elsewhere. It often happens that much may be done 
in restoring power to the bladder by inducing the patient to 
exert his own will vigorously. This is especially true in 
hysteria, in which a diseased will has often as much to do 
with the complaint as any other cause. In such cases, 
caution must be used not to resort too hastily or too freely 
to. the catheter ; but, generally speaking, in this disease, it 
is of great importance not to allow the bladder to become 
unduly distended; and to prevent this, it is necessary 
frequently to draw off the urine. 

STRANGURY. 

Perhaps this should be considered rather in the light of a 
symptom than a disease. There is, however, a more or 
less general irritation of the urinary passages, which is 
short of inflammation, and cannot, perhaps, be more appro- 
priately designated than by this term. It is exhibited in a 
frequent and irresistible desire to pass water, of which very 
little escapes, with burning and cutting pains at the neck of 
the bladder, along the urethra, and at the end of the penis, 
during and immediately after the passage. The pains often 
extend to the bladder, up the ureters, and even into the 
kidneys themselves ; and sometimes the rectum becomes 
involved in the irritation, and tenesmus is induced. The 
symptoms are those of inflammation of the whole urinary 
passages ; but the affection is often so transient, and yields 
so immediately to suitable remedies, that it can hardly be 
considered of that character. It is caused most frequently 
by irritating substances in the urine, and is a frequent 
attendant on the different forms of lithiasis or gravel. The 
most frequent cause of it, however, is beyond all comparison 
the Spanish fly, either taken internally, or applied as an 
epispastic. As resulting from this cause, it is often most 
exquisitely painful, and imperiously calls for relief. The 
oil of turpentine and other stimulating diuretics sometimes 
have the same effect. 

The treatment is very simple. After the removal of the 



638 FUNCTIONAL DERANGEMENTS. 

cause, so far as possible, an injection of from forty to sixty 
drops of laudanum in a wineglassful of mucilage will gene- 
rally afford relief, if not at first, at least upon being 
repeated. But bee tea, made by enclosing twenty or thirty 
honey-bees in a cloth, and steeping them in a cupful of hot 
water for ten or fifteen minutes, and then cooled as quickly 
as possible by setting the cup in cold water, still keeping it 
covered, and then taken at a draught, will almost always 
afford complete relief in a few minutes. As auxiliary 
measures, mucilaginous drinks should be given freely. 
Warm fomentations, emollient poultices, and the warm bath 
or half-bath may also be used. 

DISOBDERS OF SECRETION AND EXCRETION. 

The kidneys are undoubtedly emunctories by which inju- 
rious substances accidentally present in the circulation, 
effete matters resulting from the perpetual renewal of the 
organization, and any excess in the wholesome principles 
of the blood, are thrown off from the system, and thus pre- 
vented from interfering with its healthy actions. In per- 
forming this office, they appear to permit the passage of 
certain substances with little or no change, as water, urea, 
and various salts, while they occasionally decompose 
others, and eliminate the results of this decomposition in 
new forms of matter, probably not preexistent in the body. 
From this view of the functions of the kidneys, it is 
obvious that the urine may vary greatly, both in quantity 
and constitution, not only in different individuals, but even 
in the same individual under different circumstances, and 
yet still remain within the limits of health. Thus it is 
more or less copious according to the quantity of liquid 
drank, and the state of other emunctories, especially of the 
skin. One of the most important offices of the kidneys is 
to preserve the amount of fluid in the blood in due propor- 
tion to the wants of the system. The quantity of urine 
will, therefore, be increased when there is an excess in this 
proportion, and diminished when there is a deficiency. 
Consequently, other things being equal, the individual who 
drinks more largely than another will pass a greater amount 



DISORDERS OF SECRETION AND EXCRETION. 639 

of urine in the same time, and the same difference will be 
observed in the same individual at different times, according 
to his habits in this respect. Again, the urinary and 
perspiratory functions are so related, that when one is 
unusually active, the other is in general proportionably 
inert, and whatever promotes or impedes the one has an 
opposite effect upon the other. Hence the urine is usually 
more copious in the winter than in summer, after the use 
of cold than of hot drinks, and during the day than when 
the patient is warm in bed. 

The quality of the urine is not less various than its 
quantity. A full rich diet of animal food, supplying more 
nutriment to the blood than the wants of the economy 
require, is attended with an excess of the solid ingredients 
of the urine; while a purely vegetable diet, which leaves 
the blood somewhat deficient, necessitates a diminished 
elimination of nutritive matter, and produces, consequently, 
an opposite state of the secretion. The urine immediately 
following a meal in which liquids have been taken freely 
has long been noticed to be very different from that which 
occurs after digestion has been accomplished, and the rich 
chyle is poured into the circulation. The former, some- 
times called urina potus, is abundant and watery; the 
latter, denominated urina sanguinis, is moderate in quantity, 
but loaded with solid matters. Whatever promotes activity 
in the general organic processes of the system, as vigorous 
exercise, for example, and whatever renders it necessary 
that the system should live upon itself, as starvation and 
febrile diseases, promote a loaded condition of the urine, 
because the effete matters are in proportion to the activity 
of the organic changes. Even the morning urine, which 
upon the whole may be considered as offering the truest 
criterion of the normal state of the function, because least 
interfered with by disturbing causes, is more or less diversi- 
fied in character. 

Ingredients not ordinarily existing in the urine are occa- 
sionally added to it in consequence of the use of certain 
articles of food or drink. Thus, asparagus, horseradish, 

and garlic impart to it peculiar odorous principles; and 
41 



640 FUNCTIONAL DERANGEMENTS. 

saccharine matter and oxalic acid are asserted to have been 
found in it, after a free use of sugar in the one case, and of 
sorrel or rhubarb pies in the other. These foreign impreg- 
nations cannot be considered morbid unless productive of 
some injury in the economy. On the contrary, their 
presence is probably the result of a preservative process. 

It follows from what has been said, that it is impossible 
to indicate any precise condition of the urine, whether as 
to amount or quality, which can be considered as the 
healthy standard. All that can be done is to make some 
approximation to such a result. It is not surprising that 
very different opinions have been given by writers. The 
conclusions here presented are those which have appeared 
to the author most probable after a comparison of the 
various statements upon the subject. 

In relation to the quantity of urine passed daily, the 
mean for a healthy man, in temperate weather and without 
the operation of any extraordinary causes, may be stated 
at two or three pints. Women generally pass less, because 
less active and more abstemious. 

DIURESIS. 

Under this term are included all the complaints consisting 
in an excessive urinary secretion, with the exception of that 
which is characterized by the presence of sugar, constituting 
diabetes. 

Instances of diuresis are not unfrequently met with, af- 
fecting the comfort of the individual by the frequent and 
harassing calls to evacuate his bladder, often at the most 
unseasonable times, interrupting his rest at night, occasion- 
ing troublesome thirst, and, if not arrested, producing at 
length a greater or less degree of debility, and loss of flesh. 
Such cases are apt to occur in individuals of excitable or 
nervous temperament, and especially in dyspeptics, who are 
sometimes greatly alarmed lest an attack of real diabetes 
may have set in. They are, moreover, not uncommon in 
people who have passed the middle^ iife, and whose bodily 
powers have begun somewhat to fail. The affection, in such 
instances, is apt to be considered as mere irritation of blad- 



DIURESIS. 641 

der ; but, upon examination, it will be found that the amount 
of urine daily evacuated is much above the healthy average. 

The urine in profuse diuresis is usually pale or colorless, 
quite transparent, and of very low density, sometimes 
scarcely exceeding that of water. Its low specific gravity, 
the absence of a sweet taste, and the fact that it will not 
ferment with yeast, are sufficient evidences that it is not of 
the true diabetic character. 

The treatment of simple diuresis must be directed chiefly 
to the regulation of the habits of the patient, and the im- 
provement of his general health. In the first place, his 
own will should be brought to the aid of the physician. 
Occasionally, it is probable that the affection may have ori- 
ginated in, or at least may be sustained by, a habit of excess- 
ive drinking. The patient should, therefore, be induced to 
take as little drink as may be at all consistent with his 
comfort, and should avoid altogether liquids calculated espe- 
cially to stimulate the kidneys. The diet, too, should be 
of a kind least likely to provoke thirst, and salt food, and 
the use of much salt as a condiment, should be avoided. 
In order to divert action from the kidneys, all the other 
emunctories should be sustained in full operation. The 
liver, if torpid, should be stimulated by nitromuriatic acid; the 
bowels should be kept regular by rhubarb and aloes, com- 
pound extract of colocynth, sulphur, etc., the saline cathar- 
tics being prohibited ; and efforts should be especially made 
to promote the functions of the skin by the frequent use 
of the flesh-brush, by the warm or vapor bath every day or 
every other day, by woollens next the skin, and by mode- 
rate exercise. Nervous irritability should be controlled by 
narcotics and tonics. Opium often has a very happy effect, 
and is preferable to the salts of morphia, which I have some- 
times known to stimulate the kidneys actively. It may be 
advantageously given combined with an equal proportion of 
ipecacuanha at bed-time, so as to obtain at once its diapho- 
retic and narcotic effect. Of the tonics, the mineral acids, 
chalybeates, and simple bitters, including the preparations 
of Peruvian bark, may be employed. In some instances, 
the disease appears to be connected with laxity of the kid- 



642 FUNCTIONAL DERANGEMENTS. 

neys, and may be treated with astringents. In such case^ 
I have seen the oil of turpentine apparently very efficient. 
As dyspepsia is not unfrequently the basis of the disease, 
the whole regimen and course of treatment adapted to that 
affection should be made to bear upon it. 

DIABETES. 

This disease is characterized by an excessive discharge 
of saccharine urine. It probably consists essentially in the 
production and elimination of sugar, the diuresis being 
merely incidental, and dependent on the existence of that 
principle in the blood. Indeed, there is reason to suppose 
that the saccharine state of the urine may at least some- 
times precede the excessive secretion ; and it is known often 
to remain after the diuresis has for a time disappeared. 

Symptoms, Course, etc. — Diabetes is almost never recog- 
nized at its very commencement ; and it is not usually until 
after the lapse of a considerable length of time that the 
attention of the patient is called to it. The symptom which, 
in general, first attracts notice is the frequency of calls to 
evacuate the bladder, by which he is often disturbed several 
times in the course of the night. He soon also observes 
that the quantity of the urine is much increased, and acci- 
dent sometimes leads him to the discovery of its sweet 
taste. If he is now examined, there will be found, in addi- 
tion to the symptoms mentioned, thirst, a clammy state of 
the mouth and fauces, a coating of frothy mucus or white 
fur upon the tongue, constipated bowels, a dry, harsh skin, 
a sense of weariness or dull pain in the back, loins, and 
lower extremities, frequent and in some cases almost con- 
stant chilliness, a general feeling of lassitude, weakness, 
and indisposition to bodily or mental exertion, and a daily 
increasing emaciation. Dyspeptic symptoms are also fre- 
quently exhibited; such as sour eructations, oppression or 
weight in the epigastrium, burning sensations about the 
prsecordia, etc. The appetite, however, is seldom impaired, 
but, on the contrary, often somewhat increased. Thus af- 
fected, the patient may be considered as in the first stage 
of the disease. If this should continue to advance, the 



DIABETES. 643 

symptoms assume a more violent character. The discharge 
of urine is increased, and the craving for drink, and often 
for food, becomes inordinate and insatiable. From twenty 
to thirty or even forty pints of water are sometimes drank 
daily, and enormous quantities of food consumed ; and yet 
the patient is never satisfied, nay, sometimes feels the crav- 
ing increase with the means used to gratify it. Along with 
this excessive thirst and hunger, and probably contributing 
to them, are a parched state of the mouth and fauces, and 
a sensation of hollowness or sinking, with faintness, at the 
pit of the stomach. The food, notwithstanding the quantity 
consumed, produces no increase of flesh. On the contrary, 
a steadily progressive emaciation is almost always noticed, 
with increasing debility both of body and mind. The sexual 
propensity is lost, the spirits depressed, the temper soured, 
or peevish and fretful, and the memory and intelligence im- 
paired. The lungs and surface of the body exhale a sweet- 
ish odor, generally compared to that of hay. The faeces are 
said to be destitute of their characteristic offensiveness, and 
to be scanty and very dry. The tongue is now either red 
at the edges and furred in the middle, or uniformly red and 
smooth. The gums assume a dark-red or purplish hue, are 
soft and spongy, bleed easily, and often separate from the 
teeth, which are thus loosened. With this scorbutic state 
of the mouth, the breath, instead of retaining the sweetish 
odor before mentioned, becomes offensive. Occasionally a 
redness like that of the mouth is observed at the orifice of 
the urethra, and a sensation of heat is experienced along 
the urinary passages. Serious organic disease is now apt 
to set in. Tubercles are often developed in the lungs, with 
the usual attendant symptoms of pains in the chest, cough, 
dyspnoea, and purulent expectoration. Sometimes Bright's 
disease of the kidneys occurs, and is indicated by an albu- 
minous impregnation of the urine. At this stage, the patient 
sinks rapidly, the emaciation and debility become extreme, 
the fauces assume a dark-red or aphthous appearance, the 
extremities swell, the urine diminishes, loses its saccharine 
character, and at last is almost wholly suppressed, and the 
patient dies exhausted and comatose. 



644 FUNCTIONAL DERANGEMENTS. 

The presence of sugar may be easily detected by adding 
a little yeast to the urine, and keeping it at about a blood- 
heat ; if it contain sugar, it will speedily ferment and acquire 
a vinous smell. 

Causes. — These are quite obscure. It appears to be 
generally admitted that hereditary tendencies, and certain 
natural or acquired conditions of the constitution in persons 
whose parents had never been affected with the disease, act 
as predisposing causes. A residence in cold damp situa- 
tions, and in miasmatic districts, an impoverished diet, 
venereal excesses, and the abuse of mercury, are said to 
have placed the system in a condition favorable to the 
occurrence of diabetes. Among the exciting causes have 
been mentioned, exposure to cold, blow T s or other violence 
on the back, the drinking of cold water when overheated, 
anxiety or grief, and various diseases, especially rheumatism 
and gout, cutaneous eruptions repelled from the surface, and 
carbuncle or its allied affections. It must be confessed that 
all our knowledge of the causes of this complaint is ex- 
ceedingly vague and unsatisfactory. It is most frequent in 
middle life, and is rare in infancy and old age. Sex ap- 
pears to have no influence over it. 

Prognosis. — This is generally unfavorable. When the dis- 
ease is submitted to treatment in its earlier stages, there 
may be some hope of affording permanent relief, though, 
when apparently cured, the patient is liable to a renewed 
attack from comparatively slight causes, and constant watch- 
fulness is necessary during the remainder of life. Though 
the disease is cured, the predisposition remains. In many 
cases, where complete cures cannot be effected, much may 
be done towards moderating the symptoms and prolonging 
the life of the patient. In the advanced stages, treatment 
is of little avail. 

Treatment. — The indications of treatment are to prevent 
the formation of saccharine matter, which appears to lie at 
the very foundation of the disease ; to diminish the amount 
of urine discharged, which, independently of its peculiar 
character, tends, by its excess, to impoverish and deprave the 
blood, and to produce emaciation and debility; and to alter 



DIABET2S. 645 

the condition of the blood itself, which is probably the 
direct source of much of the functional and organic derange- 
ments which mark the progress of the disorder. 

To prevent the formation of sugar, we must alter the 
functional action of the stomach and liver, particularly of 
the liver, as it is now known that one of the offices of this 
organ is to manufacture sugar from the chyle, which is 
afterwards changed into the constituents of the blood. In 
diabetes too much is produced, or the necessary after- 
changes are not effected. 

The best we can do, is to put all the blood-making organs 
in as good condition as possible; and for the accomplish- 
ment of this, the reader is referred to the article on dys- 
pepsia for particular details as to the proper means, manner 
of administration, etc. Animal diet should be almost ex- 
clusively used, as it is not readily converted into sugar ; 
bread should especially be avoided, but cabbage, turnip 
and radish-tops, cresses, etc., may be used. 

Of the medicines calculated to diminish the discharge of 
urine, none is so efficacious as opium. The great advan- 
tages to be derived from this remedy are admitted by almost 
all. It not only very frequently diminishes the flow of 
urine, but also quiets the nervous irritation of the patient, 
and renders him much more comfortable. From half a grain 
to a grain of opium, with an equal quantity of ipecacuanha, 
or one-sixth of the quantity or less of tartar emetic, may 
be given at intervals of six or eight hours. Sometimes it 
may be thought best to give from ten to twenty grains of 
Dover's powder at bedtime, and none in the course of 
the day. 

Another means of lessening the quantity of urine, is to 
excite action in the surface of the body, and restore, if pos- 
sible, the perspiratory function. This should be attempted 
by the wearing of flannel next the skin, by friction with 
the flesh-brush, by the warm or hot bath, vapor bath, or 
hot air bath, by bodily exercise, and by the use of diapho- 
retics. Of the diaphoretics none is so efficacious as the 
Dover's powder already mentioned. Carbonate of ammonia 
is sometimes useful in this way. 



646 FUNCTIONAL DERANGEMENTS. 

It is highly probable that the excessive diuresis may be 
sometimes at least dependent upon a relaxation of the kid- 
neys ; and substances having a directly stimulant action on 
these organs may prove beneficial. Upon this principle it 
probably is, that the turpentines and cantharides sometimes 
lessen the flow. Cures of diabetes have been ascribed to 
the latter of these medicines. Creosote, also, has been 
highly recommended. 

SUPPRESSION OF URINE ISCHURIA RENALIS. 

By suppression of urine, is here meant either a complete 
cessation of the secretory action of the kidneys, or a dimi- 
nution of it so considerable as to be clearly morbid. It is 
undoubtedly in general, perhaps always, a mere symptom 
or effect of some other disease ; but instances occur in 
which no other affection is obvious ; and in these it must, in 
the present state of our knowledge, be considered as idio- 
pathic. Besides, a mere symptom or effect, when it consti- 
tutes the most prominent feature of the case, and the chief 
source of discomfort or danger, is often most conveniently 
named and treated as a disease ; as in the instances of diar- 
rhoea, dropsy, and the hemorrhages. Such is the case with 
the affection under consideration. 

It is difficult to determine at what point of reduction the 
renal secretion can be considered as morbid. The quantity of 
urine is often very much diminished in health, and sometimes 
only a few ounces are passed daily for a considerable time, 
without serious inconvenience. The best rule, perhaps, is to 
treat every case as morbid in which the secretion is reduced, 
for any length of time, much below the healthy standard 
of the individual, without obvious cause, such as excessive 
perspiration, or extraordinary abstinence from drink. 
Though morbid results may not always follow immediately, 
there is danger that they may occur ; and cases in which 
the suppression is entire, or nearly so, should receive imme- 
diate attention. 

The most prominent sign of suppression is the diminu- 
tion or suspension of the passage of urine ; but it is by no 
means unequivocal. It may be the result of a retention of 



SUPPRESSION OF URINE. 647 

the urine in the bladder, ureters, or pelvis of the kidneys. 
The first object, then, of inquiry, is in relation to the exist- 
ence of the latter affection. This would be indicated, if in 
the bladder, by feelings of uneasiness, fulness over the 
pubes, dulness on percussion, or more certainly still by the 
introduction of the catheter, which would be followed by a 
flow of urine. If in the ureter or pelvis of the kidney, it 
would be likely to be attended with the symptoms of ne- 
phralgia, the passage of a little bloody urine, or of a calcu- 
lus, and. if long continued, by marks of distention in the re- 
gion of the kidney, or inflammation of that organ. 

From whatever cause proceeding, suppression of urine, 
if it be complete for several days, and coma supervene, is 
almost certainly fatal. The cause of death is generally 
considered to be the depressing and poisonous action upon 
the brain of the urea accumulated in the blood, in conse- 
quence of its being no longer eliminated by the kidneys. 
It is surprising, however, under how small a daily discharge 
life may be prolonged, and ultimately preserved. In some 
instances, too, other organs appear to take on a vicarious 
office, and to relieve the system by throwing off the urea. 
Thus, in epidemic cholera, in which the urinary secretion is 
sometimes entirely arrested, the brain remains remarkably 
clear, in consequence, no doubt, of the copious discharges 
from the skin and alimentary mucous membrane. Numer- 
ous cases are on record in which the urinary secretion has 
been wholly arrested for days, weeks, or months, without 
serious disturbance of health. In these, there have gene- 
rally been liquid discharges from the stomach, bowels, or 
skin, which have sometimes had a urinous smell. 

Treatment. — In idiopathic suppression, it is highly impor- 
tant to begin with treatment early in the case, when there may 
be good hope of saving the patient. Blood should be drawn 
by cups or leeches from the small of the back. At the 
same time, brisk purgation should be effected by jalap and 
cream of tartar, senna and epsom salts, or other cathartic 
combinations having a tendency to act as well on the kid- 
neys as on the bowels. A small addition of elaterium or 
gamboge, if admissible by the stomach, would probably 



648 FUNCTIONAL DERANGEMENTS. 

be advantageous. Vigorous diuretics should then be ad 
ministered. Perhaps the most efficacious is cream of tar- 
tar, given in the quantity of an ounce or two in divided 
doses, during the day. But digitalis, squill, nitre, and the 
spirit of nitric ether, may also be given in various combina- 
tion, and in as large doses as the system will tolerate. As 
the case advances, a large blister may be applied upon the 
small of the back, on each side of the spine, and repeated 
when the surface ceases to discharge. Emetics, the warm 
bath, vapor bath, or hot air bath, and Dover's powder, have 
also been recommended; and, by effecting a vicarious dis- 
charge from the skin, may sometimes postpone the occur- 
rence of coma, while they at the same time relieve conges- 
tion of the kidneys, and thus enable these organs to feel 
the impression of remedies more especially directed to them. 
While these measures are going on, the patient should be 
allowed to drink diluent mucilaginous liquids, rendered diu- 
retic by suitable additions, as juniper, wild carrot, spirit of 
nitric ether, and the like. Should the urine be scanty, 
high-colored, and loaded with lithic acid, no medicine will 
be found more efficacious than the bicarbonate of soda, [com- 
mon soda,] which may be given to the amount of two or 
three drachms in twenty-four hours, as drink, dissolved in a 
large proportion of water. Of course, the diet should, in 
acute cases, consist of vegetable food exclusively. 

Similar measures are required in cases of suppression, 
attended with clear evidences of inflammation of the kid- 
neys or the urinary passages. The saline cathartics, and 
alkaline bicarbonates, aided by the spirit of nitric ether, or 
other mild diuretics, with the free use of mucilaginous 
drinks, will often be sufficient. The affection, as it occurs 
in infants, will in general yield readily to this treatment. 

When the disease may seem to depend upon affections of 
the brain or spinal marrow, remedies should be addressed to 
these parts especially; and, besides the general plan above 
recommended, local bleeding and blistering should be em- 
ployed as near as possible to the seat of the disease. 

In those instances of suppression which occur in the last 
stage of disorganization 'of the kidneys, whether from ordi- 



GRAVEL. 649 

nary inflammation or Bright's disease, little good can be 
expected from remedies. 

LITHIASIS GRAVEL CALCULOUS DISEASE. 

Lithiasis is characterized by the deposition from the 
urine within the body of insoluble matter, in the form of 
impalpable powder, minute crystalline particles like sand, or 
solid concretions of various magnitude, with irritation or 
inflammation of the urinary passages. 

In its most healthy state the urine is transparent when 
discharged, except a slight cloudiness from mucus and 
epithelium scales, and remains so after cooling, until decom- 
position begins. But not unfrequently, from slight excesses 
in eating or drinking, from some peculiarity of diet, or from 
some fugitive impression that can 'scarcely be considered 
morbid, the urine, though transparent when evacuated, 
becomes turbid on cooling, and deposits a sediment of 
amorphous or imperfectly crystalline matter. When tempo- 
rary, or productive of no considerable inconvenience, this is 
not looked on in the light of a disease. It is, on the 
contrary, a method by which the system frees itself from 
superfluous matters which might otherwise occasion trouble. 
But when the deposition continues long, or recurs frequently, 
and especially if the urine should be turbid at the time of 
discharge, it should be regarded as suspicious, even though 
no present inconvenience may be experienced ; for, so long 
as this state of urine remains, there will be liability to 
gravelly or calculous deposition within the body, and con- 
sequent disease of the urinary organs. 

The sediment may be either — 1. An amorphous powder 
without grittiness ; 2. A sandy matter consisting of minute 
crystalline grains, of a gritty feel, but not distinctly visible ; 
or, 3. Amorphous or crystalline concretions, sufficiently 
large to be readily distinguished by the eye, and denomi- 
nated calculi. Morbid effects in the urinary passages 
proceed in general only from the two latter kinds of sedi- 
ment. The presence of an impalpable powder in the urine 
is of consequence merely as it indicates a disordered state 
of system, or a liability to the occurrence of the other forms 



650 FUNCTIONAL DERANGEMENTS. 

of deposition, or as confirmatory of other evidence of the 
existence of a calculus in the body, and affording the means 
of ascertaining the character of the calculus. 

The chemical nature of the sediment is very different in 
different cases. All the deposits, however, may be arranged 
under the three heads of — 1. Uric acid, or the urates; 2. The 
phosphates ; and, 3. Oxalate of lime. As each of these is 
consequent upon a peculiar state of system, and attended in 
a certain degree by peculiar symptoms, they will be most 
advantageously treated of separately, so far as regards the 
deposition itself and its causes. The morbid effects of the 
several deposits, as closely analogous, will be treated of 
conjointly, and the same course will be adopted in relation 
to the treatment. 

Lithic Gravel. — This is much the most common form of 
gravel, and is highly important as, in most instances, the 
foundation of stone in the bladder. The deposit consists 
of uric acid and urate of ammonia, separately or conjoined, 
and, in some rare instances, of urate of soda. These sub- 
stances, when quite pure, are colorless ; but, as deposited 
in the urine, they are almost always of some shade of 
yellow or red ; being frequently salmon-colored, like brick- 
dust, and therefore called lateritious, sometimes yellowish, 
and sometimes, though more rarely, pink. So constant is 
this association, that the reddish color of the deposit is one 
of the characteristic signs of the uric acid lithiasis. The 
color is owing to certain organic coloring principles in the 
urine. 

The urine during the existence of the complaint is usually 
high-colored, and more or less reduced in quantity. Often 
it is very scanty. Its density does not upon the whole 
vary much from that of health. When first passed, the 
urine is often clear; and sometimes the deposition takes 
place after cooling, without much, if at all, disturbing its 
transparency. But generally it becomes turbid on standing, 
and not unfrequently, when heavily loaded, comes away 
more or less turbid from the bladder. The deposit some- 
times, though rarely, consists exclusively of crystalline 
sand. More generally this^ is mixed with a large propor- 



LITHIASIS. 651 

tion of amorphous impalpable matter; and now and then 
small concretions of the size of a pin's head or larger may 
be observed. . 

Now whatever produces an excess of uric acid in the 
circulation, or occasions the secretion by the kidneys of 
another acid when the urine is saturated with uric acid or 
urate of ammonia, or neutralizes any alkali which might 
otherwise be secreted by the kidneys and render the uric 
acid more soluble by combining with it, may serve as the 
cause of an attack of this variety of gravel. Whatever 
materially diminishes the quantity of urine may have the 
same effect, by rendering the solution too concentrated. 
Hence the frequent association of scanty and high-colored 
urine with the disposition to deposit uric acid or the urates. 
Among the causes which act most powerfully in producing 
an excess of uric acid is the use of much high-seasoned 
animal food, conjoined with indulgence in wine or other 
alcoholic drink, and at the same time with habits of indo- 
lence. 

But there is also not unfrequently a strong constitu- 
tional tendency to the disease, which occasions it to appear 
in certain individuals from causes which have no effect on 
others; so strong, indeed, in some instances, that the com- 
plaint appears, notwithstanding the most studious care to 
shun its exciting causes. 

Fevers of a sthenic character, and inflammations so 
severe as to produce fever, are frequently attended with a 
scanty, high-colored urine, which, as the complaint passes 
off, is apt to deposit a copious lateritious sediment. This 
may readily become the origin of an attack of gravel ; and 
the complaint does in fact frequently originate in a febrile 
condition of the system. Acute inflammation or high 
vascular irritation of the kidneys, and of the urinary 
passages, is peculiarly apt to induce scantiness of urine, 
and to develop gravel in those predisposed to it. 

Age appears to have some influence in this affection. 
Thus it has been noticed to be most common in infancy, 
and on the commencement of the decline of life. In the 
former case, it has been ascribed to an exclusive diet of 



652 FUNCTIONAL DERANGEMENTS. 

milk; in the latter, to a diminution of bodily exercise, 
without a corresponding reduction in the indulgences of the 
table. m 

The disease is also more prevalent in certain districts of 
country than in others. This may be owing partly to 
differences in the habits and diet of the population, partly 
to differences in the character of the climate ; damp places, 
and those much exposed to vicissitudes of weather, being 
considered most liable to renal affections. 

Exposure to cold, and injury to the kidneys from external 
violence, sometimes act as exciting causes of uric acid 
gravel. They may produce the effect by giving rise to 
irritation or inflammation of the urinary organs, and conse- 
quently to a scanty and highly-charged urine ; while cold 
probably operates additionally by checking cutaneous exha- 
lation, and thus directing to the kidneys acid matter which 
usually escapes by the skin. 

The prognosis in this form of lithiasis is generally favor- 
able. It may almost always be relieved when merely in 
the form of gravel; though, if the original predisposition 
has been strong, it may not be possible to prevent occa- 
sional returns of the complaint. 

PHOSPHATIC LITHIASIS. 

This is much less frequent than the preceding variety of 
gravel. The salts of which the deposit consists are the 
double phosphate of magnesia and ammonia, and the phos- 
phate of lime, either separate or mingled. Unmixed 
phosphate of lime is rare ; the double sort is less so ; but 
the two together are most frequent. These salts are very 
insoluble, but in healthy urine are held in solution by an 
excess of acid. They appear in the sediment sometimes in 
the form of white, shining, crystalline grains, which are, 
however, almost always mixed with a much larger propor- 
tion of a whitish or grayish amorphous impalpable powder ; 
and the latter is often present atone. The phosphatic 
deposit is distinguished by its white color, its insolubility 
in solution of potassa, and its ready solubility in dilute 
muriatic and acetic acids. In the early stages, it is some- 



PHOSPHATIC LITHIASIS. 653 

times attended with a yellowish sediment of urate of 
ammonia; but this diminishes if the complaint continues, 
and in the advanced stages almost disappears. 

The urine is usually more copious than in health, and of 
a pale color when passed. It is sometimes clear at first, 
at other times turbid ; and, in the former case, lets fall a 
sediment upon cooling, and sometimes also upon being 
heated to the boiling point, probably on account of the 
escape of carbonic acid. From this latter property it 
might be mistaken for albuminous urine ; but it may be 
readily distinguished by the solubility of the coagulum in 
an excess of nitric acid. Another characteristic is the 
frequent appearance of a pellicle on the surface of the 
urine when it has been allowed to stand for some time. 
This pellicle is gradually deposited. Phosphatic urine 
frequently presents beautifully crystalline forms under 
microscopic examination. In the beginning the urine is 
sometimes feebly acid, but more frequently neutral ; in the 
end, it is always alkaline. 

The causes of the phosphatic sediment are such as 
produce an excess of the salts, or an alkaline state of the 
urine. The phosphates being held in solution in the urine 
by an excess of acid, are of course deposited when the acid 
is neutralized or an alkali predominates. It has been 
observed that a disposition to an over-production of the 
phosphates is apt to accompany a nervous and irritable 
condition of system, marked by general debility, paleness 
of complexion, impaired digestion, and a frequent, irritated, 
easily-excitable pulse. The dyspeptic symptoms are some- 
times very prominent, with irregular bowels, and deranged 
hepatic secretion. There is often uneasiness, seldom 
amounting to pain, in the lumbar region. This condition is 
found among the poor, as a consequence of unwholesome 
food, exposure to cold and privation, and wretchedness of 
all kinds. It occurs also in those whose systems have 
been worn out by profligate habits, or by over-exertion 
whether bodily or mental. In its worst forms, there is 
often loss of appetite, a listless state both of mind and 



654 FUNCTIONAL DERANGEMENTS. 

body, peevishness or acerbity of temper, general debility, 
emaciation, and a sunken haggard appearance of the face. 
It is often associated with chronic organic affections of the 
urinary organs, uterus, rectum, or spinal marrow. 

Injuries of the kidneys, bladder, etc., from local violence 
of various kinds, occasionally precede the development of 
phosphatic lithiasis. Whatever induces chronic inflamma- 
tion of the urinary organs disposes to the affection. The 
diseased mucus which results, appears, by an influence 
analogous to that of ferment, to induce putrefaction in the 
urine while still in the bladder. The alkaline condition 
thus produced strongly favors the deposition of the phos- 
phates, which often form an abundant sediment under these 
circumstances. 

Occasionally, grief or other depressive emotion, exhausting 
mental application, or debilitating excesses, induce an 
attack of the disease, which subsides upon the removal of 
the cause. But too frequently the prognosis is unfavorable, 
in consequence of the organic mischief which lies at the 
foundation of the urinary disorder. The w T orst cases are 
said to be those in which the phosphate of lime alone is 
deposited, as this is apt to be associated with organic 
disease of the bladder. Much advantage, however, may be 
expected from treatment in cases which do not depend upon 
incurable structural lesions. 

OXALIC LITHIASIS. 

This does not usually engage the notice of the physician 
until symptoms of calculus in the kidney or bladder are 
presented. The urine is in general tolerably clear, or 
exhibits only a slight sediment on cooling. In some 
instances, deposits of oxalate of lime are said to have been 
noticed, bearing some resemblance to the phosphates in 
appearance, but they are rare. Upon the whole, it is the 
absence of sediment, in connection with the internal symp- 
toms of calculus, that excites suspicion of the existence of 
this affection. The suspicion is confirmed when crystalline 
or amorphous concretions, found in the urine, prove upon 



OXALIC LITHIASIS. 655 

trial to be insoluble in acetic acid, and solution of potassa, 
soluble in dilute nitric acid, and very slightly so in dilute 
muriatic acid. 

Little is known of the cause of oxalic lithiasis. The 
system is not obviously much deranged before the attack. 
It is highly probable that the use of sorrel, and of the foot- 
stalks of rhubarb leaves, as articles of diet, favors the 
production of oxalate of lime deposits, as both of these 
vegetables contain oxalic acid combined in excess with 
potassa. It is probable also that, when a predisposition 
exists, the free use of sugar may tend to give it effect. 
The complaint sometimes occurs in infancy, is most common 
between the ages of fifteen and fifty, and is rare in advanced 
life. 

Effects of Morbid Urinary Deposits. — These differ accord- 
ing to the character of the deposit, and the portion of the 
urinary organs upon which it acts. It has been before 
stated that, in the form of impalpable powder, the sediment 
produces no material effect in its passage. In the form of 
sand it often excites very considerable irritation throughout 
the urinary passages, from the pelvis of the kidney where 
it is deposited, to the termination of the urethra. In that 
of calculus, it gives rise to peculiar phenomena in the 
several positions which it may occupy, as the kidneys, the 
ureter, and the bladder. It will be most convenient to 
treat of these two forms distinctly. 

The commencement of an attack of gravel, in which the 
sediment is in the form of sand, so fine that no mechanical 
impediment is offered to its passage, is frequently marked 
with febrile symptoms, either as a part of that condition of 
system which leads to the deposition, or as a consequence 
of the irritation of the kidney produced by the deposited 
matter. There is an excited pulse, furred tongue, headache 
or vertigo, heat of skin, heaviness, and general discomfort, 
with not unfrequently more or less pain in the back, which 
is, however, dull and aching rather than acute. After these 
symptoms have continued for a day or two, a discharge of 
sandy matter takes place with the urine, preceded by scald- 
ing or cutting pains in the course of the ureter, and at the 
42 



656 FUNCTIONAL DERANGEMENTS. 

neck of the bladder, and itching or painful sensations at 
the outlet of the urethra, with frequent and urgent desires 
to make water, and a good deal of straining in the effort. 
These sensations are much modified in different cases, in 
some rising to the most violent strangury, in others scarcely 
exceeding a moderate burning, with a little uneasiness along 
the passages. After a short time, the symptoms become 
milder or cease for a time, to return in renewed paroxysms, 
until at length the morbid tendency of the system seems to 
give way, and the patient is restored to health ; or the 
affection assumes a chronic form, and runs on for a long 
time, perhaps indefinitely, with irregular alternations of 
remission and exacerbation. 

When concretions form so large as to come under the de- 
signation of calculi, the effects are much more serious. 
They are different, according as the calculus is in the kidney, 
ureter, or bladder. 

Calculi are almost always formed originally in the kidney, 
and are passed through the ureters into the bladder ; but 
sometimes they remain in the kidney, and occasion very 
great disturbance in that organ. 

When the calculus enters the ureter, it produces a double 
injury ; first, by its rough surface or sharp angles, wounding 
the mucous membrane ; and, secondly, by its magnitude, 
distending the coats of the tube, and thus inducing excessive 
irritation. The pain which attends its passage is sometimes 
excruciating, and perhaps equals any to which the human 
frame is liable. It is usually more or less paroxysmal, and 
has therefore been called nephritic colic. The affection has 
been already sufficiently described under the title of nephral- 
gia, to which the reader is referred. After a variable dura- 
tion of the severest suffering, the patient is often suddenly 
relieved by the escape of the calculus into the bladder, and 
it is said that the relief is sometimes preceded by a par- 
oxysm of unusual intensity, in consequence of the greater 
sensibility of the extremity of the duct. In some instances, 
the calculus is detained in the ureter, either producing com- 
plete obstruction, and consequent accumulation of urine, 
with distention, ulceration or rupture, or renal ischuria, or 



OXALIC LITHIASIS. 657 

so arranging itself in the end as to allow the urine to flow 
past it, and thus producing directly no other mischief than 
inflammation in its immediate neighborhood. In relation to 
the effects produced by the different kinds of calculi in the 
ureter, it is probable that the oxalate of lime concretions 
produce the severest pain, from their roughness and hard- 
ness, and the phosphatic the least, because less generally 
crystallized. The latter, however, are comparatively rare, 
as the phosphates are little disposed to form original con- 
cretions, and are generally produced by deposition about a 
nucleus. The uric acid concretions are greatly more 
numerous than both the others together. The character of 
the calculus may be conjectured from that of the urine. If 
uric acid or the urates are copiously deposited, the concre- 
tion may be supposed to be of the same nature ; and so also 
of the phosphates ; while the absence of all deposit, or the 
presence of oxalic acid in any state in the urine, especially 
if the nephralgic paroxysms are unusually severe, would 
lead to the suspicion that the offending cause might be the 
oxalate of lime. 

In the bladder, a small calculus does not necessarily occa- 
sion much uneasiness. The immediate relief experienced 
upon its escape from the urethra is so great that the patient 
is scarcely sufficiently upon his guard against the ultimate 
consequences. Generally, however, its presence is indicated 
by a disposition to frequent micturition, an occasional sudden 
stoppage of the stream of urine, painful spasmodic contrac- 
tions of the bladder, the discharge of blood from the urethra, 
and itching and painful sensations in the glans penis, which 
lead, especially in children, to a frequent pulling and great 
elongation of the prepuce. These symptoms are gradually 
increased. The disposition to pass water becomes at length 
extremely urgent and almost incessant, and the spasms of 
the bladder exquisitely painful. The least jar occasions 
severe suffering, so that riding in a rough vehicle becomes 
almost impossible. Vesical mucus is discharged in great 
quantities, the urine becomes offensive, and copio'us deposi- 
tions of the phosphates often take place. The general 
health at length gives way. Hectic fever ensues, with great 



658 FUNCTIONAL DERANGEMENTS. 

debility and emaciation ; and at last death from inflamma- 
tion and disorganization of the bladder relieves the patient. 
These symptoms, however, though strongly characteristic, 
should not be exclusively relied on in forming a diagnosis. 
Sounding is the only infallible method of determining the 
existence of stone in the bladder. Sometimes the stone is 
encysted; and then the symptoms are much more obscure. 
It is chiefly important to know that calculus in the bladder 
exists, in order not to confound it with other complaints; 
and to be aware of its composition, in order to the admin- 
istration of suitable palliative remedies. The latter know- 
ledge is to be obtained exclusively by the examination of 
the urine and the matters discharged with it. 

-Treatment of Lithiasis. — The means of relieving the effects 
produced upon the kidney, ureters, and bladder by calculus 
depositions are treated of elsewhere. (See the articles 
Nephritis, Nephralgia, and Cystitis.) The measures which 
require attention here are those calculated to prevent the 
deposition from taking place within the body, and to remove 
the deposited matter. As the mode of treatment is influenced 
by the character of the calculous matter, it will be proper 
to give separately the treatment adapted to the three promi- 
nent forms of lithiasis already described. 

In the uric acid variety, the indications are, 1. To render 
the uric acid more soluble in the urine ; 2. To increase the 
solvent power of the urine itself; 3. To correct the consti- 
tutional tendency to excess in the production of uric acid, 
or of any other acid which may have the property of pre- 
cipitating it from its solution ; and, 4. To remove from the 
body any calculus which may have been already deposited. 

To render the uric acid more soluble, recourse must be 
had to the alkalies or alkaline earths. These are, indeed, 
by far the most efficient remedies in this variety of lithiasis. 
The bicarbonate of soda or of potassa should be preferred, 
as less liable than the caustic alkalies, or even their carbon- 
ates, to injure the stomach and impair digestion. Either 
-of these bicarbonates may be given for a long time without 
injury. I have always employed the bicarbonate of soda, 
and seldom found it to fair in correcting, for the time, a ten- 



OXALIC LITHIASIS. 659 

dency to the deposition of uric acid or the urates. It is 
less unpleasant than the corresponding salt of potassa, and 
probably not less efficacious. By rendering the urine alka- 
line, these salts enable it to hold the uric acid in solution. 
They have the additional advantage of increasing the secre- 
tion of urine, and thus meeting the second indication. It 
is obvious that they do not correct the excessive production 
of the acid ; but they afford relief to the symptoms, and 
prevent injurious results, while other means are employed 
for effecting a radical cure. When the cause of the excess 
of uric acid is temporary, it often happens that no other 
remedies are necessary. The bicarbonates have still another 
advantage, that they are capable of dissolving the phosphates 
as well as uric acid, and consequently do not occasion the 
deposition of these salts, as the carbonates and caustic alka- 
lies are accused of doing. They should be used freely, and 
dissolved in a large quantity of liquid. The best solvent 
for them is carbonic acid water, as it is usually very accept- 
able to the stomach, and at the same time supplies any 
deficiency of carbonic acid which may exist in the salt. 
Half a drachm of bicarbonate of soda may be given, dis- 
solved in from four to eight fluidounces of carbonic acid 
water, with or without ginger syrup, four times a day. It 
should be continued until the urine ceases to yield any 
sediment on cooling, passes freely, and recovers its natural 
color ; and, if omitted, should be resumed immediately upon 
the recurrence of the symptoms. The natural mineral 
waters which have been found most useful in calculous 
complaints are those containing bicarbonate of soda. The 
red sulphur water in Macon county, in this State, has 
deservedly obtained a high reputation for the relief of gravel, 
as well as other diseases of the urinary organs. Solution 
of potassa, the alkaline carbonates, magnesia, lime-water, 
and soap, have all been employed to meet the same indica- 
tion, and all, to a certain extent, with the same effect. 
There might be circumstances under which one of these 
antacids would be preferable, as lime-water, for example, in 
cases of chronic nausea and vomiting; but, as a general 
rule, they are inferior to the bicarbonates. 



660 FUNCTIONAL DERANGEMENTS. 

To meet the second indication, that, namely, of increasing 
the solvent power of the urine, means must be employed to 
increase its quantity. Hence, the patient should drink 
freely of cool diluent liquids, such as gum-arabic water, 
flaxseed tea, and the infusion of slippery-elm, sassafras 
pith, and benne leaves. Carbonic acid water is sometimes 
a useful beverage in these cases. Benefit will now and then 
accrue from adding some diuretic substance to the drink, 
especially in chronic cases in w T hich moderate stimulation 
may not be objectionable. Such additions are the oil of 
juniper, wild carrot, and the spirit of nitric ether. It has 
been stated that the alkaline bicarbonates serve also to fulfil 
this as well as the first indication. 

In order to correct the tendency to an excessive produc- 
tion of uric acid, we must remove its causes. The patient, 
therefore, should be restricted to a vegetable diet in the 
acute form of the complaint; and even in chronic cases 
should employ animal food with great moderation. Alco- 
holic drinks should be forbidden. To prevent the genera- 
tion or accumulation of any other acid in the system which 
may tend to precipitate the uric acid, all acescent articles 
of food must be avoided, and all substances of difficult 
digestion, which may favor the production of acid in the 
stomach by diminishing its solvent powers. The alkalies 
also meet this indication by neutralizing any excess of acid 
produced. Other means calculated to prevent accumula- 
tion of acid in the circulation, are such as excite the skin 
or the bowels to increased action, and throw off the acid 
through these emunctories. In the febrile state, the neu- 
tral cathartic salts may be used as purgatives, and the 
citrate of potassa and acetate or citrate of ammonia as 1 dia- 
phoretics. The latter salts are best given in the state of 
effervescence. In the absence of fever, combinations of 
opium with ipecacuanha or tartar emetic will be useful, 
especially at bed-time. Recourse may also be had to the 
warm-bath. Flannel should always be worn next the skin. 
Moderate exercise is of great advantage, both by enabling 
the system to appropriate the food admitted into it, without 
the necessity of throwing off the excess in the form of urea 






OXALIC LITHIASIS. 661 

or uric acid, and by sustaining the eliminating function of 
the skin. 

The fourth indication is to be fulfilled by means directed 
to the solution, disintegration, or mechanical expulsion of the 
calculus. These are to be resorted to whether the calculus 
is in the kidney or the bladder. To effect its solution, no 
means are so efficacious as a very free and long-continued 
use of the alkaline bicarbonates. The urine should be 
brought into the alkaline state by these salts, and kept so 
for months if necessary. Instances are recorded in which 
there is good reason to think that even stones in the blad- 
der have been completely removed in this way. lienal 
calculi are supposed to have been sometimes disintegrated, 
and thus rendered capable of expulsion, by the use of stim- 
ulating diuretics, such as the oil of turpentine, copaiba, and 
cantharides. It is certain that sometimes, after the free use 
of these substances, large quantities of calculous matter 
have been discharged with the urine, to the great relief of 
previous uneasiness in the lumbar regions, and other mor- 
bid symptoms. 

Of the measures calculated to facilitate the passage of 
the calculus into the bladder, sufficient has been said else- 
where. {See Nephralgia.) After it has reached the blad- 
der, means should be immediately employed for its expul- 
sion, if it does not pass out spontaneously. This is of the 
utmost importance ; as it is by such precaution that the 
formation of stone in the bladder is to be prevented. 
When, therefore, there is good reason to believe that a cal- 
culus has escaped from the ureter, the patient should be 
directed to retain his urine as long as he conveniently can, 
drinking in the meantime freely of water or mucilaginous 
fluid, and, when the bladder is quite full, to bend his body 
forward so as to make the entrance of the urethra the most 
dependent part, and then to discharge his urine in a full 
stream. The urine should be carefully examined tg ascer- 
tain whether a calculus has passed. If not, the above pro- 
cess should be repeated time after time. Sir B. Brodie 
recommends that, previously to the discharge of the urine, 
a large bougie should be introduced into the bladder, and 



682 FUNCTIONAL DERANGEMENTS. 

withdrawn at the moment of the effort of micturition. The 
calculus sometimes follows the bougie immediately. Dur- 
ing the employment of these methods, the attempts to dis- 
solve or at least prevent the increase of the calculus should 
be made by the free use of the alkaline bicarbonates. 
Should the calculus become lodged in the urethra, the aid 
of the surgeon will be necessary. Should none be dis- 
charged, and yet all symptoms of its presence in the blad- 
der cease, there will be good reasons for supposing that it 
may have been dissolved ; and in the course of two or 
three weeks the efforts for its solution or expulsion may be 
omitted. 

It has been already said, that persevering efforts should 
be made to effect the solution of stone in the bladder by the 
internal use of the alkaline bicarbonates. Should this ob- 
ject not be obtained j and when the stone is of any consider- 
able size, success is hardly to be expected ; still much good 
may possibly be done by preventing further deposition, and 
thus obviating the increase of bulk and the roughness of 
the surface. 

Quite a remarkable case came under my own observation, 
in which the patient, Mr. James B. Conly, of this city, had 
been sounded, and a stone ascertained to exist, and yet, by the 
use of the following formula, the stone became disintegrated, 
and passed off in the form of fine sand, with an occasional 
gravel as large as a wheat grain. As this compound seems 
to act principally by decomposing the mucus by which the 
particles of the stone are held together, it will probably be 
applicable to all varieties of gravel. 

Formula. — Fill a vessel with white-sumach berries, and 
then pour on as much good apple vinegar as it will contain ; 
let it stand in a warm place twenty-four hours ; strain, and 
add half an ounce of sulphuric acid to a quart. Dose, half 
a wineglassful three times a day. 

Mr. Conly informs me that many others have been re- 
lieved by this means, who took it at his suggestion. 

In the phosphatic variety of lithiasis, the most important 
indications are : 1. To prevent the production of an excess 
of the phosphates; and, / 2. To prevent their deposition. 



OXALIC L1THIASIS. 663 

Their production in excess being associated with dyspepsia, 
general debility, and nervous disorder, it is important to 
obviate these several conditions by tonics, attention to the 
state of the bowels and the hepatic secretion, a proper regu- 
lation of diet and exercise, and a judicious use of narcotics. 
The whole treatment applicable to dyspepsia may be em- 
ployed. (See Dyspepsia.) In relation, however, to exer- 
cise, care must be taken, if a calculus already exists within 
the body, that it be not too violent. Opium is admitted by 
all to be an invaluable remedy in this variety of lithiasis. 
It not only quiets the irritation of the urinary organs, and 
the general irritation of the nervous system, and thus 
greatly increases the comfort of the patient ; but it controls 
also the secretion of urine, which it tends to keep in the 
proper state both as to quantity and quality. Thus it is 
asserted that no means are more efficacious in maintaining 
the healthy acidity of urine than opium. The patient 
should be kept under its moderate influence during the 
paroxysms of the disease. The dose may be from half a 
grain to a grain, two, three, or four times a day. When 
opium disagrees with the patient in all its forms, some other 
narcotic, as camphor, hyoscyamus, conium, or dulcamara 
may be resorted to. 

The deposition of the phosphates would be best pre- 
vented by rendering the urine acid. Either the sulphuric, 
nitric, muriatic, or nitromuriatic acid may be employed. 
The last would be peculiarly appropriate in cases of disor- 
dered hepatic secretion. Some of the vegetable acids 
appear to have done good occasionally in lithiasis. Thus 
cures are asserted to have been frequently produced by the 
use of hard-cider. At least, this remedy is worthy of being 
tried in the phosphatic variety of the disease. 

But it appears to be now generally admitted, contrary 
to former opinion, that the alkaline bicarbonates are the 
most efficient medicines in preventing the deposition, and 
effecting the solution of the phosphatic as well as the uric 
acid sediments. It is only the bicarbonates, however, that 
have this effect. The carbonates and pure alkalies increase 
the deposition. 



664 FUNCTIONAL DERANGEMENTS. 

No advantage accrues in this affection from an increase" 
of the secretion of urine. It is indeed frequently too copi- 
ous, and sometimes requires repression; yet the gravel 
weed, (eupatorium purpuriam,) though a diuretic, may 
often be used with great advantage. I have known several 
cases in which the use of tea made of the root of this herb 
has been followed by a free discharge of sandy material, 
and a speedy subsidence of all the symptoms of gravel. 
As the disease is often associated with chronic inflammation 
of the mucous membrane of the kidneys and bladder, and 
sometimes probably owes its obstinacy to this cause, reme- 
dies are occasionally found useful which produce an altera- 
tive impression upon these organs. Hence the turpentines 
or their volatile oil, copaiba, uva ursi, pareira brava, etc., 
may sometimes be advantageously administered. By cor- 
recting the secretion of mucus, they obviate the cause of 
the alkalinity of the urine, and consequently the deposition 
of the phosphates. It is hardly necessary to observe that 
the patient, in this as in the preceding variety of lithiasis, 
should be clothed in flannel. He should especially avoid 
the use of hard water as drink. Both the sulphate and 
carbonate of lime, often contained in such water, probably 
dispose to the phosphatic sediments. Stone in the bladder 
is peculiarly abundant in limestone regions. 

The remarks made in relation to the treatment of stone 
in the bladder in the uric acid variety of the complaint, are 
also applicable here, and need not be repeated. 

In the treatment of the oxalic lithiasis, we must be guided 
by the general condition of the system. Sometimes it may 
require a moderate antiphlogistic treatment, sometimes the 
reverse. Dr. Prout recommends mineral acids, combined 
with other tonics, in order to change the diathesis to that in 
which the disposition is to deposit uric acid. But as soon 
as any tendency to the latter sediment is observed in the 
urine, the treatment should be suspended. As tonics, Dr. 
Bird recommends sulphate of zinc, and, in anemic cases, the 
chalybeates. The shower-bath is also useful. The same 
author is favorably disposed to the use of colchicum. All 
articles of diet containing oxalic acid, or readily converted 



RETENTION OF URENK. 665 

into it, should be forbidden. The patient should, therefore, 
avoid sorrel, as a salad, should never eat rhubarb pies, and 
should partake very moderately of sugar. Indigestible 
substances generally should be excluded from the diet, and 
none of the fermented liquors allowed. Dr. Bird considers 
a very small quantity of brandy and water at meals as the 
best beverage. Flannel should be worn next the skin. 
Little or nothing can be done by remedies to dissolve the 
oxalate of lime when deposited. So far as regards me- 
chanical measures for expulsion, the same rules are applica- 
ble as to the uric acid calculi. 

RETENTION OF URINE. 

When urine is secreted, but not evacuated, it is said to 
be retained, and the affection is denominated retention of 
urine. This may occur in the kidneys or in the bladder. 

RENAL RETENTION. 

This is not always easily distinguishable from suppres- 
sion of urine, in which the secretory function is suspended 
or abolished. In both, the discharge of the urine either 
greatly diminishes, or entirely ceases ; and in both the signs 
which indicate fulness or distention of the bladder are 
wanting, and little or no urine escapes upon the introduc- 
tion of a catheter. In retention, however, there is much 
more pain than in suppression. There is, also, in the 
former a distressing sense of weight, or distention, in the 
lumbar region ; great uneasiness is produced by strong 
pressure in the loins ; and it is asserted that the ureters 
and kidneys have sometimes been so much distended as to 
form a fluctuating tumor, discoverable from without. Be- 
sides, the retention is seldom complete. Occasionally there 
may be a considerable discharge of urine, consequent upon 
a partial removal of the obstruction ; and, if no urine pass 
the obstructed point, still a portion may enter the bladder 
from the opposite kidney, and escape by the urethra. In 
suppression, there is either no discharge, or the quantity is 
very small, and liable to little diversity. 

The consequences of renal retention, unless the obstriic- 



666 FUNCTIONAL DERANGEMENTS. 

tion be speedily removed, are very serious. If the obstruc- 
tion exist in the upper part of the ureter, the pelvis of the 
kidney, and even the kidney itself, become greatly dis- 
tended; and the renal structure has sometimes been so 
much stretched out as to form a sort of membranous bag. 
When the lower part of the ureter is closed, this tube be- 
comes also vastly dilated above the point of obstruction. 
In some instances, there is reason to believe that suppres- 
sion is induced in consequence of the pressure upon the 
secreting vessels, and death speedily results from this 
cause. In other cases, inflammation, suppuration, and com- 
plete disorganization of the kidney take place, with rupture, 
and all the fatal consequences of effused pus and urine. 

The most frequent causes of renal retention are calculi in 
the ureter, or at its origin in the pelvis of the kidney. 
Co.agula of blood or fibrin may produce the same effect. 
Obstruction of the passage may also arise from inflamma- 
tory thickening of the coats of the ureter, or the pressure 
upon it of tumors from without. 

VESICAL RETENTION. 

Retention of urine in the bladder is, in general, very 
easily distinguished. The occurrence of inability to make 
water leads to an examination of the bladder, which is felt 
above the pubis, forming a roundish, well-defined, and some- 
times visible tumor. Occasionally, however, in very fat 
persons, or in tympanic states of the abdomen, it cannot be 
easily distinguished by the touch. In this case, the dulness 
upon percussion over the whole region which it occupies, 
contrasting with the resonance of the surrounding space, 
will be sufficiently diagnostic. A complication of ascites 
with retention might cause some embarrassment ; but the 
peculiar pain produced by pressure on the distended blad- 
der, or, if this fail, the introduction of a finger into the 
rectum, or of a catheter into the bladder, will soon decide 
the question. The distention goes on increasing with the 
continuance of the retention ; and the bladder sometimes 
acquires enormous dimensions, reaching to the umbilicus, or 
even, in some rare instances, as high as the pit of the 



VESICAL RETENTION. 667 

stomach. It has, under these circumstances, been mis- 
taken for ascites. 

There are two conditions of retention, which materially 
differ in their symptoms : one, in which the affection is sud- 
denly induced ; the other, in which it comes on gradually. 
In the former there is usually much pain in the hypogas- 
trium and perineum, with a constant and distressing desire 
to pass water, but ineffectual, notwithstanding the storngest 
efforts. The pain is much increased by pressure over the 
pubes. If the affection continues, the patient becomes 
feverish, restless, anxious, and exceedingly distressed, until 
at length a portion of the bladder or urethra gives way, and 
the urine escapes either into the peritoneum, with inevitably 
fatal results, or, more frequently, into the neighboring cellu- 
lar tissue, producing inflammation, sloughing, and generally 
death. When the retention is partial, and the accumulation 
in the bladder gradual, this viscus accommodates itself in 
some measure to the pressure, and may be greatly distended 
without much uneasiness. The ureters, and even the pelvis 
of the kidney, sometimes participate in the distention: 
Sooner or later, however, unless relieved, the same symp- 
toms are apt to come on as in the acute form, and with the 
same fatal result. 

The causes of vesical retention are twofold ; namely, ob- 
struction of the urethra, and a loss or diminution of the 
contractile power of the bladder. Obstruction may arise 
from inflammatory swelling of the mucous membrane and 
cellular tissue at the entrance of the urethra ; and, in this 
case, the symptoms of irritable or inflamed bladder are 
added to those properly belonging to the retention. It may 
also arise from spasmodic contraction of the sphincter fibres, 
under the influence of cold, direct irritation, inflammation, 
or nervous disorder, especially hysteria. Other causes of 
obstruction are a pendulous tumor falling upon the entrance 
of the urethra, tumors of the uterus or vagina, the gravid 
uterus pressing on the neck of the bladder, and more fre- 
quently still, especially in old people, enlargement of the 
prostate. But the most frequent obstruction of all is that 
from stricture of the urethra. Diminished contractility of 



668 FUNCTIONAL DERANGEMENTS. 

the muscular coat may arise from the debility of old age, 
the deficient innervation of low fevers, and cerebral or 
spinal disease, attended with paralysis. In these cases, the 
retention is not complete. When the bladder is to a certain 
degree distended, even though it may have lost all muscular 
power, its elasticity is sufficient to overcome the feeble re- 
sistance of the sphincter, and a portion of the urine escapes, 
in general involuntarily. This happens especially at night; 
and there is some danger of mistaking the affection for in- 
continence, unless the practitioner is on his guard. In states 
of system in which the patient is insensible, as in typhoid 
fevers, there is peculiar liability to this mistake, which may 
lead to serious consequences. This state of the bladder is 
often very annoying. All voluntary power of evacuation is 
lost, but with every movement which causes gravity to favor 
the discharge of the urine, and with every unusual degree 
of pressure on the bladder, as in coughing or sneezing, a 
portion of the urine escapes involuntarily, producing irrita- 
tion, and even excoriation of the skin with which it comes 
in contact, and an excessively disagreeable odor about the 
person. Such cases are a combination of retention and in- 
continence. The very act of distention has the effect of 
debilitating the muscular coat, and, in the end, if continued, 
of entirely destroying its contractile power. Hence the 
habit of resisting the desire to evacuate the urine may, if 
long enough continued, gradually induce retention. 

Treatment. — Renal retention, if consequent upon inflam- 
mation, must be treated by means adapted to the cure of 
nephritis; if upon calculi or coagula in the ureter, by those 
which are recommended under lithiasis and nephralgia. In 
vesical retention, when proceeding from inflammation at the 
neck of the bladder, bleeding, leeching, saline cathartics, 
antimonials, emollient cataplasms, and the warm bath, are 
suitable remedies, and will seldom fail. To attempt to re- 
lieve the complaint with the catheter would, in general, only 
aggravate the irritation. This instrument should be resorted 
to in this and the following case only when rendered abso- 
lutely necessary, in order to relieve very painful or danger- 
ous distention. When spasm is the cause of retention, an 



VESICAL RETENTION. 669 

anodyne enema will be the most effectual remedy. Tobacco 
or lobelia cataplasms to the perineum may also prove useful. 
In these cases, too, the tincture of chloride of iron, and the 
alcoholic solution of ammoniated iron, have been recom- 
mended. Should the spasm be hysterical, or should the 
incontinence depend upon hysteria in any other way, the 
remedies applicable to this protean disease must be em- 
ployed, and especially cups or leeches, with subsequent 
blistering or pustulation over the spine. But care should 
be taken, in such cases, not hastily to resort to the catheter ; 
for if once used it is again and again called for, and becomes 
at length a necessary source of relief. When the obstruc- 
tion is purely mechanical, as from stricture of the urethra, 
enlarged prostate, etc., the catheter becomes indispensable ; 
and if this cannot be introduced, the bladder must be punc- 
tured. Such cases, however, belong to the surgeon. 

Retention arising from deficient power in the muscular 
coat must be treated according to the circumstances in which 
this loss of power originated. If the seat of disease is in 
the spine, cups, blisters, antimonial pustulation, and setons 
or issues to the back, are appropriate remedies. If the 
paralysis of the bladder is only a part of a general affec- 
tion, dependent on disease of the brain, it must be treated 
accordingly. If quite local, or connected with general de- 
bility, it is to be encountered by tonic treatment addressed 
to the system, and stimulants to the bladder itself. The 
cold bath, and the cold douche to the. perineum and pubes, 
are sometimes useful by rousing a salutary reaction. Qui- 
nine, tincture of chloride of iron, uva ursi, buchu, cubebs, 
oil of turpentine, and cantharides, have all been recom- 
mended, and may be tried successively, or variously com- 
bined. Aloetic laxatives should be preferred in order to 
keep the bowels regular, unless the patient should be trou- 
bled with piles. Repeated blistering to the sacrum will 
occasionally prove useful, and electricity may be tried with 
the hope of benefit. In these cases, the use of the catheter 
is important in order to prevent distention of the bladder, 
which has the effect of increasing its debility. It should 
be introduced at least twice a day, and if more frequently 



670 * FUNCTIONAL DERANGEMENTS. 

used, so much the better. After recovery, the patient 
should be scrupulously careful to obey the calls to pass 
water in due time, lest accumulation should take place and 
produce distention. 

INCONTINENCE OF URINE. 

In this affection, there is a want of power to control the 
discharge of urine, which is evacuated involuntarily. There 
are two very different conditions of the urinary organs, both 
of which are attended with incontinence. In one, the blad- 
der is so highly irritated that the sphincter, though in a 
healthy state, cannot resist the urgent desire of micturition ; 
in the other, the sphincter is debilitated or palsied, and is 
unable to obey the will in resisting the ordinary action of 
the bladder. In the former, the bladder may be inflamed 
or highly irritated, so as to be unable to tolerate the presence 
of healthy urine ; or the urine may be morbidly acrid, so as 
unduly to excite the bladder, though this may have been 
previously in a normal condition. This sort of incontinence 
also frequently accompanies stone in the bladder. 

But it is the second condition which constitutes true in- 
continence. In this, the sphincter either relaxes under less 
than the ordinary stimulation from the urine, or is quite 
destitute of the power of contraction, so that no other 
impediment exists to the escape of urine than the pressure 
of the soft parts upon the channel of the urethra, a resist- 
ance which the slightest force is sufficient to overcome. 

Not unfrequently both these conditions exist in the same 
case — the bladder being irritated to more than its ordinary 
contraction, while the sphincter has less than the ordinary 
power of resistance. 

Under the influence of sudden emotion, especially of fear 
involuntary discharges of urine sometimes take place. These 
can be considered as morbid only when they occur habitually, 
or from comparatively slight causes. 

The most frequent form of incontinence is that in which 
the sphincter retains considerable contractile power, but 
yields habitually to slight impulses when the will is not 
sufficiently on its guard, or when it is to a considerable 



INCONTINENCE OF URINE. 671 

degree inoperative, as in sleep. Involuntary discharge of 
urine at night is a frequent and very disagreeable affection. 
It is most common in children before puberty, and is apt to 
cease spontaneously after this period, but is sometimes pro- 
longed into adult age. Though in itself of little importance 
to the health, it often becomes highly important in its moral 
influences, sometimes affecting the character and whole future 
life of the patient. The discharge during sleep frequently 
occurs in consequence of dreams ; but often also it is alto- 
gether involuntary, without the least consciousness on the 
part of the patient, and dependent solely upon the relaxa- 
tion of the sphincter under the stimulus of the urine. It 
is said that the position of the patient has some effect, and 
that he is more apt to make water when lying on the back 
than upon the face or side. I have, however, some doubts 
of the accuracy of this statement. Occasionally the incon- 
tinence is experienced also during the day, so that the 
patient cannot retain his urine so long as persons in ordinary 
health. This affection is often attended with an acrid con- 
dition of the urine, which is high-colored, and loaded with 
uric acid in solution, or even with sediments of the acid or 
its salts. In this case, there is a combination of irritation 
of bladdor with debility of the sphincter. More frequently, 
however, the kidneys seem to participate in the debility of 
the sphincter, and a pale watery urine is secreted in unusual 
quantity. The affection appears to be hereditary, or at 
least occurs frequently in several members of the same 
family. 

A variety of incontinence analogous to the above occa- 
sionally arises from irregular nervous action, especially in 
hysterical cases. There is in these cases less a positive 
debility of the sphincter than an irregularity of innervation, 
which is as often excessive as deficient. 

But the most deplorable cases of incontinence are those 
which are connected with complete paralysis of the sphincter, 
or a total loss of power in the muscular fibres thus denomi- 
nated, in consequence of mechanical injury, as from the 
operation of lithotomy in females, and from severe labors. 
The paralysis of the sphincter may not extend to the mus- 
43 



672 FUNCTIONAL DERANGEMENTS. 

9 

cular coat of the bladder generally, in which case the urine 
will be occasionally discharged in a jet, when from position 
or other cause it has accumulated considerably ; or the blad- 
der may share the same loss of power, and then incontinence 
may become involved with retention ; the bladder being fre- 
quently full or distended, while the urine dribbles away 
whenever the elasticity of the coats is sufficient to overcome 
the slight resistance of the urethra, or gravity favors the 
discharge. This condition of things is most common in the 
old, and is sometimes associated with disease of the pros- 
tate. The disease, like retention from a similar cause, may 
be quite local, or may be associated with paralysis of other 
parts from disease of the brain or spinal marrow. 

Treatment. — The variety of incontinence connected with 
an irritated state of the bladder, or an acrid condition of the 
urine, must be corrected by removing its cause. The proper 
remedies will be found under the heads of irritable bladder, 
cystitis, nephritis, and lithiasis. An anodyne enema is among 
the most effectual means of affording present relief. In the 
cases dependent on debility of the sphincter, such as noc- 
turnal incontinence, the indications are to restore tone to 
the system at large, if debilitated, and to stimulate the 
sphincter. The first object is to be accomplished by the 
bitter tonics, mineral acids, chalybeates, sea-bathing, the 
cold bath, and due attention to clothing, diet, and exercise. 
For the latter purpose, astringents or tonics, having a pe- 
culiar reference to the urinary organs, may be first tried, 
such as uva ursi, pipsissewa, and pareira brava ; and these 
may be aided by the cold douche to the sacrum, perineum, 
or pubes. Should these fail, recourse may be had to the 
more active urinary stimulants, as buchu, cubebs, oil of 
turpentine, or cantharides. On the whole, I have found no 
one remedy so effectual as cantharides, pushed so far as to 
produce slight irritation of the urinary passages. I was 
once consulted in the case of an interesting little girl of 
eight or nine years of age, who had never been able to retain 
her urine from birth. Chalybeates and the tincture of can- 
tharides completely cured her in less than a month. In 
bad cases, blisters to the sacrum may be employed. The 



INCONTINENCE OF URINE. 673 

patient himself should be induced to aid the efforts of the 
practitioner. Much may be done by firm resolution on his 
part. Yet a resort to chastisement, recommended by some 
writers, in cases in which the will is not concerned, is not 
only cruel, but nugatory, as the fears excited have of them- 
selves a relaxing effect on the sphincter. Little or no drink 
should be allowed in the latter part of the day or evening ; 
the patient should fully evacuate the bladder before going 
to sleep ; and a good plan is to awaken him for the same 
purpose late at night, before the period at which he usually 
wets the bed. Any method which will serve to break the 
habit will often be found serviceable. When the complaint 
is connected with hysteria, the peculiar treatment adapted 
to that affection must be employed. 



674 FUNCTIONAL DERANGEMENTS. 



CHAPTER VI. 

FUNCTIONAL DERANGEMENTS CONNECTED WITH THE NERVOUS 

SYSTEM, . 



FUNCTIONAL DERANGEMENTS OF THE BRAIN. 

Before entering upon the special affections, there is one 
preliminary consideration which it is necessary to present 
to the reader. A remarkable fact, familiar to all patho- 
logists, is, that similar phenomena very often proceed from 
precisely opposite conditions of the brain; so that it is 
occasionally very difficult to decide from the symptoms 
alone what is its real pathological state. We find an 
analogy to this in electricity, which produces the same 
effects whether it be positive or negative. 

NERVOUS IRRITATION. 

The brain is peculiarly susceptible to irritation of an 
essentially nervous character; that is, without necessary 
participation of the blood-vessels. Too exclusive an im- 
portance has, I think, been attached to the state of the circu- 
lation in this organ. All the morbid phenomena have been 
ascribed by some pathologists to too much or too little 
blood, or to its unequal quality or distribution. These are 
undoubtedly frequent sources of cerebral disorder ; but the 
brain is also frequently excited into disease without them. 
The nervous system has a peculiar mode of action of its 
own, in which, though blood may be necessary as an instru- 
ment, it is not the main operating principle. This action is 
susceptible of exaltation, depression, or depravation in 



VASCULAR IRRITATION. 675 

itself, and from the influence of its own peculiar agents. 
The fact here stated is not of merely speculative interest ; 
it is in the highest degree practically important; and a 
vast deal of mischief has been done by looking to the 
blood-vessels exclusively as the seat or source of cerebral 
disorder. But, in thus asserting for the nervous functions 
a capacity of exclusive and independent disease, we must 
not forget that their irritation frequently in the end 
involves the blood-vessels; and that the affection, if not 
relieved, may terminate, though not necessarily, in active 
congestion or inflammation. 

As the offices of the brain are numerous, so also must be 
the signs of its excessive excitement or irritation. To 
enumerate all these in the present place would be quite out 
of the question. Irritation of the brain obeys the general 
laws of that morbid affection. If moderate, it exalts the 
healthy functions without otherwise altering them; if 
stronger, it more or less deranges the functions ; in great 
excess, it entirely changes or abolishes them. Any thing 
which is capable of making a strong impression on the brain, 
either through the medium of the intellect or emotions, or 
through the nerves acting upon other organs, may become a 
cause of irritation of the brain. 

The treatment consists in removing the cause, and in the 
use of all those means calculated to quiet the nervous 
system, or to draw off the excitement by revulsion. 

VASCULAR IRRITATION, OR ACTIVE CONGESTION. 

Among the most common symptoms are a sense of ful- 
ness, weight, or distention in the head ; giddiness ; head- 
ache of every grade and variety ; increased sensitiveness to 
sound, with buzzing, roaring, and other perversions of 
hearing; double, partial, luminous, painful, dim, or other- 
wise disordered vision, with muscse volitantes, scintillations, 
etc. ; tingling, formication, neuralgic pains, numbness, and 
partial or complete loss of sensation in various parts of the 
body ; nausea and vomiting ; morbid vigilance, or perhaps 
more frequently oppression, heaviness, drowsiness, and 
stupor in various degrees ; mental confusion, loss of memory, 



676 FUNCTIONAL DERANGEMENTS. 

and delirium; and finally subsultus, spasm, convulsions, or 
the opposite condition, indicated by muscular weakness, 
tremors, and temporary paralysis of motion. It is, of 
course, understood that all these symptoms are not present 
in any one case. They are, indeed, often contradictory, 
and could not exist together. There may be one only, or 
a few, or there may be many variously grouped. 

Active congestion of the brain is sometimes of itself 
serious, and may prove fatal ; but its greatest danger is as 
the precursor of inflammation of the brain or its membranes, 
or of apoplectic effusion. Another injurious result, com- 
mon to this and the preceding variety of cerebral disorder, 
is the establishment in the brain, under frequently-renewed 
irritations, of a habit which may lead to the recurrence of 
the phenomena from slight causes, and even, in some 
instances, without any apparent exciting cause, as in 
epilepsy, some forms of hysteria, chronic headache, etc. It 
is a condition which requires attention, and by the proper 
management of which, at an early period, much subsequent 
suffering and danger may be prevented. 

Causes. — It is very apt to be the result of the continu- 
ance of an irritation primarily purely nervous. But there 
are certain causes more especially operative, such as direct 
injury to the head by falls, blows, etc., exposure of the 
head to intense solar or artificial heat, external cold, 
alcoholic stimulants, the exciting passions, febrile diseases, 
translated gouty or rheumatic irritation, suppressed dis- 
charges, teething in children, hypertrophy of the left 
ventricle, and various intestinal and stomachic disorders. 
The sanguineous temperament, a plethoric state of the circu- 
lation, and an over-richness of the blood, may be considered 
as constituting predispositions to it. Men are probably 
more subject to it than women. It is common in infancy, 
at the age of puberty, and from that up to maturity, and 
again in advanced life. 

Diagnosis. — It is sometimes highly important to distin- 
guish active congestion of the brain from passive congestion, 
depression, or mere nervous irritation. In relation to the 
two former of these affections, the reader is referred to the 



DEPRESSION. 677 

subsequent part of this article. From nervous irritation it 
is to be distinguished chiefly by the state of the circulation. 
In active congestion the face is usually flushed, the eyes 
suffused, and the whole countenance often turgid. If the 
patient is sensible, he is apt to complain of fulness, disten- 
tion, or heaviness of the head ; and any vertigo or head- 
ache which he may have is much increased by stooping, 
with the head downward. 

Treatment. — The treatment in this affection, indepen- 
dently of the measures necessary for the removal of the 
cause, which should never be neglected, is chiefly depletory, 
sedative to the circulation, and revulsive. Local bleeding, 
purging, the warm bath, the antimonials when the stomach 
is not irritable, other saline refrigerants, cold to the head, 
and hot pediluvia, mustard, blisters, etc., to the extremities, 
with low diet, rest, and an elevated position of the head, 
are the principal remedies. Very often, in mild cases, the 
symptoms may be removed by a saline cathartic and atten- 
tion to the diet. When serious, however, recourse should 
always be had to the lancet. The internal use of aconite 
has been highly recommended. It must be remembered 
that, though the warm bath may be useful, the hot bath 
might prove injurious by over-stimulation. But no perma- 
nent benefit can be expected while the offending cause 
remains. This, therefore, should be diligently sought for, 
and removed or corrected if possible. 

DEPRESSION. 

In this condition the activity of the brain is diminished 
either by a directly depressing influence, or the withdrawing 
of an accustomed stimulus. 

The symptoms are chiefly headache, vertigo, disordered 
vision and hearing, wakefulness, delirium, convulsions, and 
coma. There is not, as from the moderate influence of the 
other affections, increased cerebral energy ; as indicated by 
greater acuteness of sensation, more brilliancy of imagina- 
tion, a more rapid flow of just thought and expression. 
These can only result from a positive excitement of the 
brain ; but all the other phenomena attending nervous and 



678 FUNCTIONAL DERANGEMENTS. 

vascular irritation may be experienced. It may seem 
strange that obstinate wakefulness and violent convulsions 
should be among the effects of cerebral depression; yet 
few facts in medicine appear to me to be better established. 
Thus, take away from the brain a stimulus to which it has 
been long accustomed, and one of the first results is morbid 
vigilance ; and this condition is a not unfrequent attendant 
on the debility which succeeds exhausting acute diseases. 
The last vital act of the system, expiring under the loss of 
blood, is sometimes convulsions. It is well known that all 
the phenomena of advanced meningeal inflammation, or 
acute hydrocephalus, are sometimes imitated in children in 
the lowest stages of exhaustion from bowel affections ; and 
the brain is found apparently healthy after death. 

The causes of cerebral depression are long-continued or 
excessive cold; the depressing passions, such as fear and 
grief; various sedative poisons, as tobacco, digitalis, and 
hydrocyanic acid ; the irrespirable gases, as hydrosulphuric 
acid, carbonic acid, carburetted hydrogen, etc.; deficiency 
in the general amount of blood, or in its supply to the 
brain ; an impoverished state of the blood ; an excess of 
carbonaceous matter, and the presence of urea and bilious 
matter in the blood; the withdrawing of an accustomed 
stimulus ; and, secondarily, any excessive excitement when 
it ceases. Of course, all the modes of living, the kinds of 
exposure, the accidents, the diseases which produce any of 
the above conditions, may act as remote causes of cerebral 
depression. To enumerate them here would be only to 
occupy space with what is already familiar to the reader. 

Treatment. — Tonics, stimulants, external irritants, and a 
nutritious diet, with the means necessary to remove the 
causes of the affection, are indicated in this condition of the 
brain. In cases at all doubtful, those stimulants should be 
preferred which have the least permanent impression upon 
the brain, such as carbonate of ammonia, oil of turpentine, 
capsicum, musk, and assafoetida ; while external stimulation 
by means of rubefacients, blisters, the hot bath, etc., and 
the powerful influence of electro-magnetism, should be 
mainly relied on, when deemed sufficient to meet the exi- 



MECHANICAL OR PASSIVE CONGESTION. 679 

gencies of the case. Should the respiration have been sus- 
pended, it should be restored artificially. This is especially 
important in the cases of poisoning from irrespirable gases. 
The shock of cold water suddenly dashed upon the surface 
is sometimes very effective, by rousing the suspended sen- 
sibilities of the brain. 

MECHANICAL OR PASSIVE CONGESTION. 

This results from causes interfering with the return of 
blood from the cerebral vessels. The blood accumulates in 
the veins and sinuses ; the capacity of the arteries is of 
course diminished; less arterial blood is admitted than is 
necessary for the support of the functions ; and we have the 
double result of compression and depression of the brain. 

The characteristic symptoms of this condition are a feel- 
ing of fulness, weight, and sometimes coldness in the head, 
an actual diminution of temperature in this part, a strong 
tendency to drowsiness or stupor, vertigo, faintness, im- 
paired vision, forgetfulness of things or words, dulness of 
countenance, a livid or purplish hue of the lips and differ- 
ent parts of the face, with paleness, occasionally nausea, 
and depression in the functions of circulation and respira- 
tion. 

The causes are ligatures around the neck, tumors press- 
ing upon the venous trunks, gravitation, and such an 
organic or functional derangement of the heart and lungs, 
as to impede the passage of the blood either into the right 
side of the heart, or from the right to the left side through 
the lungs, and consequently to produce accumulation in the 
descending cava. 

The treatment consists exclusively in the removal of the 
cause, and, when this is impossible, in the adoption of 
measures calculated to proportion, as nearly as may be, the 
calls of the system upon the cerebral centres to their 
diminished capacity. The avoidance of all kinds of excess, 
mental or physical, is especially requisite. 

HEADACHE, OR CEPHALALGIA. 

In the widest acceptation, this may be considered as em- 



680 FUNCTIONAL DERANGEMENTS. 

bracing all kinds of uneasy sensation in the head. Very 
often it is wholly independent of the brain, being seated in 
the scalp or cranium. Such is the case with many in- 
stances of gouty and rheumatic headache, neuralgia, vari- 
ous inflammatory affections of the exterior coverings of the 
cranium, or of its sinuses, and syphilitic affections of the 
periosteum or bony case itself. These do not belong to the 
complaint as here considered, which is exclusively cerebral. 

Headache is of every different degree, and of every con- 
ceivable diversity of character. It may be confined to 
one small spot, in which case it is sometimes called davits, 
as if it might proceed from a nail driven into the head ; it 
may occupy a particular region of the cranium, as the 
frontal immediately over one or both eyes, the temporal, 
the parietal, or the occipital ; it may embrace one side of 
the head, as in hemicrania; or it may be diffused, and of 
indefinite extent. Sometimes it is fixed, sometimes change- 
able in its position. It may be apparently superficial, or 
may seem to be felt in the depths of the brain. It is not 
less various in duration than in the other respects men- 
tioned. It may continue but for an instant, or may last for 
hours, days, or weeks. Indeed, instances have occurred in 
which it has never been absent from the patient, during 
consciousness, for months or years. Much more frequently, 
however, when so durable, it occurs in paroxysms with in- 
tervals of. comparative or entire ease, the exacerbations 
being quite irregular in their recurrence. Not unfrequently, 
however, headache is regularly periodical, being either re- 
mittent or intermittent, and generally of the quotidian or 
tertian type, though the interval is sometimes longer, and I 
have known it to occur regularly once in two weeks, with- 
out association with any natural periodical function. The 
pain may be simple, or may be mingled with various other 
perverted sensations, such as of giddiness, fulness or disten- 
tion, weight or lightness, emptiness, heat or coldness, hiss- 
ing, buzzing, ringing, or roaring in the ears, and the sight 
of dark or luminous spots, scintillations, double vision, half- 
vision, dimness of vision, and temporary blindness. 

Headache may be a result of any one of the pathological 



HEADACHE. 681 

conditions of the brain. It appears to be the favorite sign 
by which nature makes known any deviation whatever from 
the normal state of the brain. Viewed in this light, it may 
be looked on as a safeguard, intended to give notice of dis- 
ease which might otherwise escape attention, till too late to 
be remedied ; and its indications should never be neglected. 
We should not be content till it has been traced to its 
source, however hidden : for it is not the pain only that we 
are called on to relieve, but often the more serious affection 
of which it is a mere symptom. 

For the sake of convenience, we may consider headache 
as symptomatic when the result of some known disease, and 
idiopathic when the pathological state on which it may de- 
pend cannot be ascertained, or is not recognized among 
special diseases. It is obviously nothing more, strictly 
speaking, than a symptom in either case. 

Symptomatic headache is exceedingly common, and asso- 
ciated with a great number of diseases. It is an almost 
uniform attendant on different forms of meningeal and cere- 
bral inflammation ; and is usually the first sign by which 
other organic affections of the brain, such as tumors, hyda- 
tids, and morbid growths or formations of all kinds, declare 
themselves. As the direct result of vascular irritation of 
the brain, it is one of the most common symptoms of all 
febrile diseases, whether idiopathic or symptomatic. Anae- 
mia and plethora are also affections which frequently occa- 
sion headache, though from opposite causes. 

Idiopathic headache is also not uncommon. It is usually 
distinguished by the name of nervous headache. It is ex- 
ceedingly irregular in its modes of attack, duration, and 
recurrence, as well as in the character of the pain. Some- 
times coming on suddenly in a state of apparently sound 
health, it prostrates at once the mental as well as physical 
energies of the patient, and, after a longer or shorter period, 
leaves him as abruptly as it approached, and with all his 
powers restored. Sometimes it interrupts and prevents 
sleep ; but more frequently the patient, though tormented 
during the day, will go to sleep at the usual hour, and upon 
awaking find that the pain has left him for a time. More 



682 FUNCTIONAL DERANGEMENTS. 

frequently than any other variety of headache, this assumes 
the regular periodical form. In most instances, probably, 
the pain is in the front of the head, over one or both eyes; 
but it is occasionally felt in the occiput, and is often diffused 
without a definite seat. Not unfrequently it occurs in the 
form of hemicrania. It may be dull and grumbling, or 
heavy and throbbing, or sharp and lancinating like neural- 
gia. After continuing a certain length of time, it not un- 
frequently provokes vomiting; but differs from sick-head- 
ache in the circumstance, that the matter discharged from 
the stomach may be quite destitute of acid, bile, or any 
acrid property. Its duration is entirely uncertain. One 
attack seldom continues long ; but the patient is liable to 
frequent returns of it, in many instances, for months or 
years, and in some even for life. It is purely functional, 
and leaves no traces in the brain after death. The head- 
ache itself never proves fatal ; but it may, in the end, so 
far wear out the strength as to render the system less able 
to support the assaults of other diseases, and may thus con- 
tribute to shorten life. 

The causes of it are quite obscure. One of the most 
common is, I believe, the use of coffee, tobacco, and strong 
tea. Sedentary habits, combined with much mental exer- 
tion, and loss of sleep, sometimes give rise to it, independ- 
ently of any primary disease of stomach. Occasionally I 
have observed the breath to smell offensive. It has ap- 
peared to me that, in many instances, this variety of head- 
ache is nothing more than one of the protean forms of 
nervous rheumatism. 

Treatment. — For the treatment of symptomatic headache, 
the reader is referred to the various diseases of which it is 
an accompaniment. Under the heads of sick-headache, and 
neuralgia, he will find remedies for varieties of the disease 
in its nervous form. The treatment adapted especially to 
hemicrania is detailed under the last-named affection. It is 
only for the disease in its idiopathic form that the mode of 
treatment is here given. 

The first and most important point is to discover and re- 
move the cause. In the first place, if the patient is in the 



HEADACHE. 683 

habit of using either strong tea, coffee, or tobacco habitually, 
he should be advised to try the effect of abandoning it for 
three or four weeks, by way of experiment. Very often 
he will find the headache relieved by this simple measure, 
and then will be sensible of the propriety of abstaining 
from the poison altogether. Should this measure fail, it 
will be necessary to seek for some other cause ; and if there 
is any one suspicious article of diet, the same course should 
be pursued with that as with the substances mentioned. 
The patient should also sleep sufficiently and regularly, 
should not overtask his mind or allow himself to be worried 
and perplexed by business or other cause, and should exer- 
cise freely in a pure air. If a citizen, he should be advised 
to take a journey into the country. A long voyage is occa- 
sionally very useful. Sometimes a complete change of life — 
the substitution, for example, of the business of farming 
for that of a merchant or professional man in cities — has a 
most salutary effect. It need scarcely be added that the 
bowels should be kept regular, and the functions of the 
stomach, liver, kidneys, skin, and uterus, in a healthy state. 
The pain may almost always be temporarily relieved by 
opiates or other narcotics ; and sometimes, when it is very 
severe, it becomes advisable to have recourse to these reme- 
dies ; though their habitual use should be most sedulously 
guarded against. The nervous stimulants or antispasmodics 
also frequently afford relief. One of the best of these is 
Hoffmann's anodyne, of which a fluidrachm may be given ; 
but, on the whole, I have found nothing more effectual than 
two or three cups of strong tea. When the disease depends 
upon the use of tea or coffee, this remedy acts simply like 
ardent spirit in relieving the horrors of intemperance. It 
should, under these circumstances, not be employed, as it 
aggravates the evil in the end. But in other cases it will 
be found a valuable resource. Chloroform liniment will 
nearly always afford at least temporary relief. Ether applied 
in the hollow of the hand to the forehead, lotions with spirit 
of lavender, Cologne water, or bay-rum, the application of a 
mustard plaster to the back of the neck or the temples, or 
blisters behind the ears, are sometimes advantageous. 



684 FUNCTIONAL DERANGEMENTS. 

In relation to the permanent cure, sulphate of quinia 
should always be employed in intermittent cases, and may 
be tried with the hope of good in others. When there is 
any suspicion of gout or rheumatism, recourse should be 
had to occasional purgative doses of sulphate of magnesia 
and wine of colchicum, to which a full dose of sulphate of 
morphia may sometimes be added. The chalybeates should 
be used in anemic cases. If the disease prove obstinate, 
the whole round of remedies recommended in neuralgia are 
at our command. 

STUPOR AND WAKEFULNESS. 

These opposite conditions are mentioned here, not with a 
view to minute description, but chiefly in order to call 
attention particularly to the fact that they may each of 
them be the result of a depression or elevation of the cere- 
bral actions. 

By stupor is meant that condition of the brain which con- 
sists in a suspension more or less complete of the animal 
functions, while those of the organic life continue, and which 
bears a close resemblance to sleep, except in the circum- 
stances that it is much less under the control of the will, 
and depends upon some morbific cause. Under the name 
may be included various grades of the affection, from heavi- 
ness or slight drowsiness to absolute coma, in which all con- 
sciousness is lost, and from which the patient cannot be 
roused. It may be produced at any time by pressure upon 
the brain, whether proceeding from vital causes, forcing too 
much blood into the cerebral vessels, or producing effusion 
within the cranium; or from mechanical causes, as depression 
of the bone, or impediment to a return of blood from the 
head. We must therefore be upon our guard in cases of 
coma, and prepared to treat it upon the principle either of 
morbid pressure, of simple excess of irritation, or of de- 
pression. As the result of the last-mentioned cause, it fre- 
quently follows the influence of sedative narcotic poisons, 
such as tobacco, digitalis, or hydrocyanic acid, or the admis- 
sion of venous or carbonated blood into the arteries of the 
brain. Coma in children, with largely dilated pupils, and 



MENTAL DISORDER. 685 

not ascribable to any obvious cause, may be conjecturally 
referred to narcotic poison, and, under circumstances favor- 
ing that supposition, may be treated with a gentle emetic. I 
have known of several such instances, in which an emetic 
brought up a quantity of stramonium or Jamestown seeds. 

Wakefulness or morbid vigilance certainly proceeds in many 
instances from an over-excitement of the brain, whether 
merely nervous or vascular. Thus it is a frequent incident 
in the early stages of meningeal inflammation and insanity. 
It is well known, also, to be produced in many persons by 
coffee and tea, which powerfully stimulate the nervous sys- 
tem, with little effect upon the vascular; and is a com- 
mon attendant upon the excitement of joy, hope, or antici- 
pation. It appears to be a lower grade of that vascular 
excitement which, carried farther, ends in stupor. 

Very commonly a depression of the vascular actions of 
the brain, or a purely nervous depression, produces some 
grade of stupor ; but occasionally it may also give rise to 
morbid vigilance ; and this I consider an important practical 
fact. We see it, as already observed, and as will hereafter 
be fully shown, proceeding from the suspension of the use 
of. powerful stimulants; (see Delirium Tremens;) and it is 
a frequent result of great general debility, without being at 
all traceable to any irritant cause. 

The remedies, whether for stupor or wakefulness, are to 
be addressed to the pathological condition, whatever that 
may be, and will be found detailed elsewhere. It may be 
stated here that coffee and tea may often be advantageously 
used. 

MENTAL DISORDER. 

To this head belong delirium, insanity, and certain less 
usual forms of derangement, of which those especially de- 
serving of notice appear to be ecstasy and somnambulism. 
Delirium, in its different forms and relations, has been, or 
will be, sufficiently treated of elsewhere, in connection with 
the diseases of which it is a symptom. Insanity forms the 
subject of a distinct article. 

It remains, then, in this place, only to notice the two 



686 FUNCTIONAL DERANGEMENTS. 

disorders above alluded to under the names of ecstasy and 
somnambulism. These are curious mixtures of sensorial 
and intellectual disturbance, which approach more nearly 
to delirium or insanity than to any other form of cerebral 
disease. 

ECSTASY. 

This is an affection in which, with a loss of consciousness 
of existing circumstances, and insensibility to impressions 
from without, there is an apparent exaltation of the intel- 
lectual or emotional functions, as if the individual were 
raised into a different nature, or different sphere of exist- 
ence. The pulse and respiration may be natural, or more 
or less depressed ; the face is usually pale ; and the surface 
of the body cool. If the pulse is increased in frequency, it 
is usually more feeble also. The duration of the attack is 
very uncertain, in some instances not exceeding a few min- 
utes, in others extending to hours or days. 

Upon recovering from the spell, the patient generally 
remembers his thoughts and feelings more or less accurately, 
and sometimes tells of wonderful visions that he has seen, 
of visits to the regions of the blessed, of ravishing harmony 
and splendor, of inexpressible enjoyment of the senses 
or affections. After the attack is over, he may return 
entirely to his ordinary health and ordinary pursuits, or 
he may exhibit some permanent change of character, as 
the result either of the disease or of the causes which pro- 
duced it. 

The disease is usually brought on by causes which occa- 
sion a strain upon the mental functions ; a profound exercise 
of thought, for example, or an overwhelming excitement of 
the emotions or affections. It is most frequent in persons 
of a nervous temperament, and women are therefore pecu- 
liarly subject to it. 

The treatment is simple. During the continuance of the 
spell, little more is required than to take care that the pa- 
tient is supplied with nourishment. Should symptoms of 
prostration appear, they should be counteracted by external 
and internal stimulation. Should vascular irritation, on the 



SOMNAMBULISM. 687 

contrary, threaten serious injury to the brain, it might 
become necessary to resort to the various measures already 
recommended for that condition. In obstinate cases, the 
most effectual remedy would probably be to shave and blis- 
ter the head. After the attack, attention should be paid to 
the general condition of the functions ; and especial care 
should be taken to avoid all causes of excitement. 

SOMNAMBULISM. 

This is a state of the system in which, with an apparently 
rational concatenation of thought, and the power of consist- 
ent action, the patient has completely lost the consciousness 
of his actual condition, and, in a greater or less degree, the 
susceptibility to ordinary exterior influences. As it occurs 
most frequently at night, during sleep, and as the patient is 
apt to rise from his bed and walk about the house or abroad, 
persons affected with it are commonly called sleep-walkers. 

Symptoms. — The most striking phenomenon in the affec- 
tion is the obvious unconsciousness of the patient of his 
real position. Like a dreamer, he fancies himself under 
circumstances which do not really exist, but, unlike the 
/nere dreamer, has the power of acting in accordance with 
those circumstances. He rises from his bed in pursuance 
of some course of action in which he supposes himself en- 
gaged, or to accomplish some purpose which his fancy has 
suggested, and all his movements are well concerted to those 
ends. He appears to be utterly insensible to danger, and 
frequently puts himself in situations, as upon the roofs of 
houses, or on the brink of precipitous heights, in which, if 
awake, he would incur hazard from the loss of self-command. 

If left to himself, the sleep-walker generally returns to 
his bed, sleeps naturally, and awakens at the usual time, 
quite unconscious of the incidents that have taken place, 
though sometimes fatigued by his exertions. He can often 
be awakened by disturbing him considerably in any manner; 
but among the most effectual methods is to throw cold water 
upon the surface. 

Causes. — The causes of somnambulism are not alwayy 

obvious. Sometimes it appears to be connected with de 
44 



688 FUNCTIONAL DERANGEMENTS. 

rangement of the alimentary canal or of the uterus. In- 
temperance is said to have occasioned it. In very mild 
forms, it is not uncommon in children ; but generally ceases 
before adult age. The severer forms of it are said to occur 
most frequently in men under the middle age. The affectior 
is asserted to be hereditary. 

MOTOR DISORDER. 

The motor faculty may be deranged in two modes, inde- 
pendently of a morbid increase under the influence of the 
will, in which case it is the latter faculty that is affected, 
and the patient may be considered as insane. The two 
modes of derangement alluded to are involuntary contrac- 
tion or spasm, and loss of the power of motion, or palsy. 
To the latter subject a special article will be devoted. Of 
spasm, there are several varieties. One striking distinction 
is into clonic and tonic spasm, the former consisting in rapidly 
alternating contraction and relaxation, as in subsultus tendi- 
num and convulsions, the latter of contractions having a 
certain duration, and attended with rigidity or hardness of 
the muscle, as in common cramps, and in tetanus. 

convulsions. . 

These are clonic spasms of the muscles, producing 
visible motions of the limbs or other parts of the body, 
and generally attended with unconsciousness. When the 
contraction is slight, feeble, and short-continued, so as 
to occasion a mere catching of the tendons, with very little 
observable movement of the parts into which the tendons 
are inserted, the affection is denominated subsultus tendinum. 
It may or may not be accompanied with unconsciousness. 
It is an inferior degree of the same condition that exists in 
convulsions, often takes place under the same circumstances 
and from the same causes, and is not unfrequently a precur- 
sor of them. 

The attack of convulsions may either be preceded by 
other signs of nervous disorder, or may come on abruptly, 
without warning. The voluntary muscles of all parts of 
the body may be affected, or the spasms may be confined 



CONVULSIONS. 689 

to one-half of the body, to a single limb, or to the features. 
There may be only a single attack, or several in more or 
less rapid succession. During the paroxysm, the face is 
sometimes pale, sometimes purplish or livid, the lips are 
bluish, the features often apparently swollen, the jugulars 
distended, and the pulse frequent and irregular. Involun- 
tary evacuations now and then take place. The duration 
of the convulsions is exceedingly variable. It may be only 
a few moments, or it may extend to hours or days ; but, in 
the latter case, there is always some remission or intermis- 
sion of the convulsive movements, though the comatose 
symptoms continue. Perhaps the average duration of each 
paroxysm may be stated at from five to fifteen or twenty 
minutes. Upon its subsidence, the patient is generally dis- 
posed to sleep, and not unfrequently remains somewhat 
comatose for a longer or shorter period. In some infantile 
cases, however, the child is bright and lively immediately 
after the cessation of the convulsions. Occasionally, when 
the paroxysm is over, it is found that some serious cerebral 
or spinal lesion has taken place, as indicated by the exist- 
ence of partial paralysis, strabismus or squinting, and various 
mental disorders ; and sometimes the paroxysm is only the 
commencement of a series of subsequent attacks, occurring 
at irregular intervals, and constituting epilepsy. In these 
cases, it is obvious that the disease passes out of the cate- 
gory at present under consideration. 

Convulsions sometimes end fatally, though not often, 
unless connected with other disease. Simple uncomplicated 
functional convulsions are seldom very dangerous. In fact, 
the affection is itself probably, in many instances, a safe- 
guard, by directing irritation from the nervous centres to 
the circumference. Nevertheless, convulsions may prove 
immediately the cause of death, by interrupting the due in- 
nervation of the lungs or heart ; and they always demand 
a vigilant attention, as the possible evidence of very serious 
disease. 

Causes. — The peculiar state of the nervous system in in- 
fancy and early childhood may be considered as a predispos- 
ing cause. Very impressible from the necessities of the 



690 FUNCTIONAL DERANGEMENTS. 

organization at this age, it must of course feel more sensibly 
than at other periods of life the influence of disturbing 
causes. But there is also a great difference in children in 
this respect. In some, the nervous system is peculiarly 
liable to this mode of derangement, either from inheritance, 
from powerful impressions, as some suppose, upon the ner- 
vous system of the mother during pregnancy, or from some 
inappreciable cause, which often determines, in all the chil- 
dren of certain parents, a predisposition of this kind. Noth- 
ing is more common than to see all or most of the children 
of one family peculiarly subject to convulsions, though the 
parents may have shown no such tendency in their own 
persons. Children thus predisposed show themselves more 
impressible than others by ordinary causes, start frequently, 
are unusually excitable, if not properly controlled, are apt 
to be fretful or irascible, and occasionally exhibit great pre- 
cocity. Among adults, females are, for the same reasons, 
more subject to convulsions than males. 

The predisposition to the disease may also be induced by 
impure air, unwholesome diet, and whatever has a tendency 
to lower the general standard of health. For reasons ex- 
plained elsewhere, the anemic condition strongly predisposes 
to convulsions. 

The exciting or immediate causes are very numerous. 
Strong and sudden emotion, as fear, anger, surprise, etc., is 
a frequent cause. Insolation, excessive artificial heat, ex- 
posure to cold, over-exertion, and falls or other accidents, 
may induce convulsions. But they are much oftener the 
result of an irritation transmitted to the brain from some 
other part of the body. One of their most frequent sources 
is the irritation of teething. Perhaps even more so is that 
proceeding from indigestible or acrid substances in the ali- 
mentary canal. Articles of food not readily dissolved by 
the infantile stomach are very often the cause of convulsions. 
So also are acid in the stomach and bowels, intestinal worms, 
and the acrid secretions consequent upon disordered hepatic 
function. Whatever occasions spasm in the intestines may 
induce convulsions ; for there is nothing which more power- 
fully discomposes the infantile nervous system than violent 



CONVULSIONS. 691 

pain. A cause, perhaps not sufficiently appreciated, is the 
milk of the mother or nurse. This occasionally produces 
the effect, even when the nurse is apparently healthy. It 
is said that agitating or exciting emotions will sometimes so 
affect the milk as to induce convulsions in the suckling. 
The use of certain articles of food or of medicine may have 
the same effect. I have known convulsions in the infant to 
be the apparent result of antimonial medicines administered 
to the mother. Irritating purgatives, or other medicines, 
have sometimes the same effect directly on the child. The 
reader cannot be too strongly impressed with the importance 
of looking to the gums and to the alimentary canal of chil- 
dren as the seat of the cause of convulsions. The retreat 
of an habitual irritation from the surface of the body is 
another occasional cause. Hence, convulsions sometimes 
follow the disappearance of a cutaneous eruption. The 
irritation of whooping-cough sometimes provokes them. 

Too great vascular fulness or excitement may induce the 
disease in those predisposed to it ; and if at the same time 
there exist peculiar nervous disturbance, convulsions will 
be very apt to result. Hence their great frequency in feb- 
rile diseases. Some children never have an attack of fever 
without convulsions. They are peculiarly frequent in the 
exanthematous fevers. 

Treatment. — This divides itself into such as may be 
proper in the convulsion, and such as may be required after 
it has subsided. During the paroxysm, the patient should 
be placed where he may breathe a fresh and pure air, of a 
moderate temperature, and especially not too much heated ; 
and every part of the dress which may act in any degree as 
a ligature, should be loosened. Hot water may be imme- 
diately directed for the feet, sinapisms may be got ready 
for the extremities, and if the head is at all heated or 
flushed, cold water may be applied to the scalp. After 
failure with all these measures, a gentle emetic of ipecacu- 
anha, if the patient can swallow, will sometimes put an 
immediate end to the paroxysm. 

The feet may be enveloped in poultices of bread and 
milk, or flaxseed meal, mixed with well-bruised garlic or 



692 FUNCTIONAL DERANGEMENTS. 

onions ; brandy heated with garlic, or a mixture of oil of 
amber, olive oil, brandy, and laudanum, may be applied 
warm along the whole length of the spine, and over the 
abdomen ; and assafoetida, musk, oil of turpentine, or oil of 
amber, may be injected into the rectum. If the gums are 
much swollen, and apparently painful, they should be freely 
lanced. 

In the interval, a full cathartic dose of calomel should be 
administered, to be followed in due time, if it do not operate 
thoroughly, by a dose of castor oil. The head should be 
kept cool; any existing febrile excitement met by means 
of the antimonials or neutral mixture ; and nervous disturb- 
ance controlled by gentle antispasmodics, such as sweet 
spirit of nitre, Hoffmann's anodyne, or camphor water. At 
the same time, gentle revulsion should be maintained 
towards the extremities ; the bowels should be kept in a 
soluble state by saline laxatives, and the diet should be 
restricted to farinaceous substances, or in infants to these 
with the milk of the nurse in moderation. Should there 
be a disposition to the return of the convulsions, more 
decided revulsion should be effected by means of blisters 
between the shoulders or to the extremities. 

In the cases of pure irritation, 'besides removing the 
cause, it is proper to diminish the nervous susceptibility, 
and to control the cerebral irritation, by diffusing the excite- 
ment over the whole nervous system. To meet the first 
indication, narcotics may often be employed with advan- 
tage ; and none is more efficacious than opium, which, to 
diminish its stimulant influence, may be combined in some 
instances with ipecacuanha. Hyoscyamus, lactucarium, or 
conium may be substituted, if on any account thought 
preferable. The second indication, above alluded to, is to 
be fulfilled by antispasmodics, administered by the mouth, 
the rectum, or the skin, and by the use of tonics, of which 
the metallic are deemed most efficient. Of these the oxide 
of zinc has perhaps enjoyed most reputation, though the 
chalybeates should be preferred in anemic cases. Should 
the digestion be impaired, and the system at large feeble, 
the simple bitters or quinine might be preferable to the 



CONVULSIONS. 693 

metallic tonics. These various remedies may often be com- 
bined in the same prescription. Thus, opium or hyoscyamus, 
assafoetida, and either oxide of zinc, carbonate of iron, sul- 
phate of quinine, or extract of gentian or quassia, may very 
properly go together. The cold or shower bath, cautiously 
used, may also serve to strengthen the nervous system. 
Fresh air and a nutritious diet of easy digestion are 
important. 

But an account of the treatment would be imperfect 
without a more particular reference to the mode of removing 
some of the more prominent causes. When the gums are 
in fault, they should be freely lanced ; and, if the tendency 
to convulsions continue, a pair of blisters should be applied 
behind the ears. If the affection is connected with acid in 
the stomach and bowels, recourse should be had to the 
antacids, of which magnesia may be used when a laxative 
effect is desired; carbonate of lime, if diarrhoea exist; 
aromatic spirit of ammonia, when a stimulant effect is 
indicated ; and one of the alkaline carbonates, or bicar- 
bonates, when there is no especial indication, and the 
extrication of carbonic acid in the bowels is not feared. 
The existence of worms would lead to the employment of 
calomel as a purge, and of oil of wormseed, or oil of turpen- 
tine, as an anthelmintic. 

Any derangement in the hepatic secretion should be care- 
fully observed, and treated with minute doses of calomel, 
blue-pill, or mercury with chalk. When the disease depends 
on intestinal spasm, great advantage will often accrue from 
the use of laudanum with assafoetida, or spirit of ammonia 
by the mouth, the injection of musk into the rectum, the 
application of a mustard cataplasm, or blister over the 
abdomen. Should the disappearance of a cutaneous erup- 
tion have preceded the convulsion, efforts should be made 
to restore it by friction with croton oil, or other active 
irritant. In urgent cases, a blister might be produced by 
means of the strong solution of ammonia on the surface 
previously affected. Finally, great attention must be paid 
to the diet of the patient, in order that nothing irritating 



694 FUNCTIONAL DERANGEMENTS. 

should enter the stomach ; and when there is any reason to 
suspect the milk of the mother or nurse, it should be 
changed for that of a perfectly healthy woman. 

CATALEPSY. 

This term is used to designate an affection characterized 
by a loss more or less complete of consciousness, with a 
peculiar rigidity of the muscles, causing the body, and each 
portion of it, to retain the position in which it may have 
existed at the moment of attack, or in which it may after- 
wards be placed. The disease is seldom idiopathic or 
solitary ; but is generally combined with some other affec- 
tion, especially hysteria, somnambulism, and insanity. It 
may attack both sides of the body, one side only, or a 
single limb. Sometimes the attack is preceded by signs of 
nervous disorder, sometimes comes on without premonition. 

When the whole body is attacked, the patient becomes 
stiff like a statue, and remains standing, sitting, or lying, 
according to the posture at the time of seizure. Upon any 
attempt to move the limbs by another, though there is some 
degree of stiffness, they generally yield to the impulse, and 
afterwards retain the position in which they may be placed, 
however ludicrous or seemingly painful. The features are 
usually composed ; though it is said the muscles of the face 
obey the general law, and that the same expression of 
countenance is retained as may have been exhibited at the 
moment of attack. The pulse is variously affected, being 
in some instances healthy, in others accelerated, and in 
others diminished both in frequency and force. During the 
continuance of the attack the evacuations are either sup- 
pressed or involuntary. 

The duration is quite uncertain : it may be only a few 
minutes, or it may extend to hours or days. In some cases 
the attacks are repeated with greater or less frequency, 
and in this way the complaint may continue for months or 
years. Upon the solution of the paroxysm, the patient 
often complains of headache, and a feeling of muscular sore- 
ness or fatigue; but is in general wholly unconscious of 



INSANITY. 695 

what has passed, and sometimes, it is said, resumes a con- 
versation or action in which he may have been engaged 
when attacked, at the point at which it was interrupted. 

There is usually in the intervals some evidence of 
nervous disorder, very often connected with derangement of 
the alimentary canal, or, in the female, of the uterus. 

Causes. — An excitable condition of the nervous system, 
analogous to that which exists in hysteria, constitutes a 
predisposition to this affection. Women and children are 
peculiarly liable to it. Any strong emotion, or unusual or 
protracted intellectual exertion, may serve as an exciting 
cause. Strong sexual desires, or excessive indulgence, are 
said to have brought on attacks. Paroxysms of the disease 
have also been ascribed to worms, to the retrocession of 
cutaneous eruptions, and to the cessation of habitual dis- 
charges. Probably the most frequent exciting causes are 
stomachic, intestinal, and uterine irritations. 

Treatment. — Purging is indicated, especially in cases of 
amenorrhcea, in which aloes should be employed in full 
doses. Cold should be applied to the head, if it be in any 
degree heated. The warm bath may be tried, though its 
utility is not universally admitted. All the organic func- 
tions should be maintained as nearly as possible in the 
healthy state. Any spinal irritation that may exist must 
be corrected in the usual manner. Should the paroxysms 
be periodical in their recurrence, quinine might be expected 
to prevent them. Anemic cases would require the cha- 
lybeates. Debility must be counteracted by tonics, the 
shower-bath, or sea-bathing, exercise in the intervals of 
attack, and a nutritious, easily-digested diet. Should respi- 
ration be suspended, it should be restored artificially. 

INSANITY MADNESS MENTAL DERANGEMENT LUNACY. 

Insanity is a general term, including all derangements of 
the intellectual and moral functions not forming a part of 
some other recognized disease, nor an ordinary physiologi- 
cal result of the time of life. 

The disease is seated essentially in the brain. It is 
through that organ exclusively that we think, and experi- 



696 FUNCTIONAL DERANGEMENTS. 

ence emotion; and derangements in these two modes of 
mental exhibition, whatever may be their remote cause, are 
necessarily cerebral disorders. But insanity is by no 
means a simple mental condition. The brain, if not a com- 
plex organ, certainly has complex functions ; and it may be 
deranged in the whole of these functions, or in one princi- 
pally, or in any number of them, and there is scarcely an 
end to the diversity of mental disorder which may thus 
arise. Some arrangement, however, is necessary for the 
purpose of description; and I know of none better than 
that which divides the disease into general and partial 
insanity, mania and dementia, belonging to the first divi- 
sion, and moral insanity, monomania, and insane impulse, 
to the second. 

By general insanity is meant a derangement, in a greater 
or less degree, of all the cerebral functions connected essen- 
tially with mind ; by partial insanity, a derangement of a 
portion only of these functions. Mania is that form of 
general insanity in which there is an exaltation of the cere- 
bral actions ; dementia, that in which the brain is enfeebled, 
and the mental operations all participate in its weakness. 
Partial insanity takes the name of moral insanity, when it 
appears to affect only the emotional functions, as contradis- 
tinguished from the intellectual ; of monomania, when, with 
a general soundness of thought, there is delusion upon 
some one point, or in some one direction ; and of insane 
impulse, when, without reflection, and without any known 
perversion of the feelings or passions, the patient is irresisti- 
bly impelled to some insane act. Each of these modes of 
insanity requires a distinct description. 

It is necessary to guard against the mistake of suppos- 
ing that all cases of insanity can be referred clearly to one 
or the other of these varieties. Each one of them is occa- 
sionally w T ell characterized ; but cases are constantly occur- 
ring, either intermediate in their nature, or combining the 
peculiarities of two or more of the varieties, so that it 
would be impossible to refer them to any one division ; and 
the same case occasionally exhibits, in its different stages, 
all the different phases of the disease. 



MANIA. 697 



MANIA. 



This form of mental derangement is more common than 
any other, and is the most easily recognized. It consists 
in an unhinging of the mind, a general disturbance of the 
mental powers, a want of co-operation among the different 
faculties. Most usually, however, the imagination is the 
most in fault, and the will the least. The judgment is 
also frequently little disturbed, the subject coming to cor- 
rect conclusions, supposing his premises to be correct. The 
disorder sometimes comes on very suddenly as the conse- 
quence of some great mental shock, or as a sequela of an 
acute disease; but generally its approaches are slow, and 
i friends are long coming to the conclusion that the subject 
is deranged, attributing his waywardness and the incongru- 
ity of his conduct to eccentricity or other causes, and it is 
not until he breaks out into some violent excitement that 
they entertain the idea of insanity. The history of this 
disease, its diagnosis, and its medico-legal aspect would 
occupy a volume; we will therefore leave it to the good 
sense of friends to determine where sanity ends and insan- 
ity begins, and proceed to make a few observations on its 
management. 

As a general rule the patient should be at once sent to 
some well-regulated lunatic asylum; his chance of recovery 
is incomparably greater in these establishments as now con- 
ducted than at home among friends. One thing which will 
account for this is that almost uniformly the patient takes 
an aversion to his relatives and most intimate friends, often 
imagining that they have conspired together to take his 
life. The consequence is that he will submit to any other 
rather than to them. Then, every arrangement about a 
modern asylum has been made, under scientific control, to 
conduce to the happiness, comfort, safety, and easy control 
of the inmates, and then he will be under the immediate 
eye of an intelligent physician who makes mental diseases 
a speciality, and has been chosen for his fitness to take 
charge of patients suffering from this class of disease. In 
every view of the subject, therefore, it is advisable to 



698 FUNCTIONAL DERANGEMENTS. 

remove the patient, as soon as possible, to an asylum foi 
the insane. But if this can not be done, then the follow- 
ing measures will give the patient the next best chance of 
recovery. 

Every artifice should be resorted to to avoid irritating 
the patient, and no allusion should ever be made to the 
subject of his insanity, but some plausible explanation 
should be made to him to account for his peculiar feelings. 
The medical treatment most proper in such cases is quite 
plain and simple; his bowels should be kept rather active 
by saline purgatives, and a sufficient amount of opium 
given every evening to insure sleep; cold water should 
be applied daily, either by the shower-bath or sponging; 
his diet should be light but nourishing, and a succession of 
small blisters should be kept up along the spine. 

If it is suspected that the suspension of any ordinary 
drain, as hemorrhoidal flux, discharge from an old sore, or 
chronic diarrhea, etc., has brought on the disease, it should 
be restored, or a substitute set up. Any discoverable de- 
parture from health should be met by appropriate remedies. 

DEMENTIA. 

This is characterized by general feebleness of all the 
mental powers. It differs from idiocy only in that in the 
latter there never was any active mental power, and that 
in the former there will generally be retained rational ideas 
which have been, as it were, stereotyped on the brain. It 
may come on as an original disease, but generally is a con- 
sequence of a previous condition of active mania, and hence 
offers little hope of an amendment. Time and good treat- 
ment are our dependence in such cases. 

MORAL INSANITY. 

In this form of mental aberration it is supposed that the 
emotions are only concerned, causing the subject to hope 
or fear, to love or hate, to be joyous' or melancholy, with- 
out cause and without reason. But as very high authority 
has now taken ground against the existence of moral in- 
sanity, as well as insane impulse, deciding that nothing can 



MANIA. 699 

properly be called insanity without hallucination, and as 
both have been made the excuse for the perpetration of 
the foulest crimes, we will pass them over without further 
comment. 

MONOMANIA. 

This form of insanity stands upon better ground than 
the last named, as it is often attended by the wildest hallu- 
cination, the subject imagining himself somebody else, or 
that he occupies a different position in society from what 
he does, as that he is governor, king, etc. It seems to be 
the effect of a derangement in one or more compartments 
of the brain, while all the others are in good working order. 

The world can afford very many instances in which per- 
sons have acquired, and deservedly, too, high distinction in 
certain pursuits or in particular departments of literature, 
which, if examined into critically, have been the result of 
what might not inappropriately be denominated congenital 
monomania. That is, the individual owes his superiority in 
the department in which he has excelled to a morbid devel- 
opment of a particular department of the brain. Thus an 
excessive development of the organs of ideality, compari- 
son, and language may enable one to engage in fields of 
romance, or weave most beautiful and entrancing poetical 
fabrics, which are often, indeed, a "thing of beauty and a 
joy forever;" and yet, if you become intimately acquainted 
with the author, you will perceive that on every other sub- 
ject he is not only weak as other men, but perhaps is so 
deficient in other respects that he becomes a source of vexa- 
tion, mortification, or pecuniary expense, to his friends. 0, 
how humiliating is it to know that many of our brightest 
literary and poetical gems are the product of an unbalanced 
mind, rendered monomaniacal by inheritance or disease ! 

Hypochondria appears to be a variety of monomania, dif- 
fering in that the brain, in this case, is only sympathetically 
affected by its association with derangement of the liver 
and other digestive organs. 

In the management of the insane there should be as much 
of liberty as is consistent with the safety of the patient and 



700 FUNCTIONAL DERANGEMENTS. 

others ; as little as possible of forcible restraint. Nothing 
that can be avoided should remind him of his difference 
from other men. His apartment, though well secured, 
should not look like a prison cell. In all his movements he 
should be carefully watched and guarded, when not well 
enough to be trusted to himself; but this should be done in 
a manner not to excite his suspicions. The attendance 
upon him should appear in the form of friendly care, com- 
panionship, or service, as the case may be, not of the watch 
of a jailer over his prisoner. Nothing more excites anger 
and maintains a turbulent spirit in the insane, than violent 
restraint. Independently of its positive discomfort, they 
feel it as an unprovoked and unwarrantable injury. How 
is it possible for a brain to recover its regular and calm 
movements, when 'thus tortured by fierce excitement? 
Happily, the days of chains, dungeons, the scourge, and 
starvation are passing away. But it is mournful to reflect 
upon the numbers formerly goaded into incurable madness, 
or sunk into hopeless mental impotence, who under judi- 
cious management might have been restored to comfort and 
usefulness. 

DELIRIUM TREMENS MANIA A POTU. 

This is the delirious affection which follows the suspen- 
sion of the habitual use of alcoholic drinks or other stimu- 
lants. Its essential character consists in the cerebral 
debility consequent upon the cessation of an accustomed 
excitement. The most prominent symptoms are delirious 
hallucinations, the dread of impending evil, muscular tre- 
mors, and the want of sleep. 

Should circumstances, however, prolong the abstinence or 
privation, this preliminary condition becomes aggravated, and 
the disease is fully formed. The perceptive faculties are 
now disordered ; and the patient receives false impressions 
through his senses, which he at first often recognizes as 
imaginary, and may even be disposed to smile at, but which 
soon acquire in his convictions all the force of reality. Not 
unfrequently it happens, for a time, that the phantasms 
seem real at night or in darkness, and either vanish or are 



DELIRIUM TREMENS. 701 

known for what they are by daylight. The patient sees 
the most grotesque, frightful, or disgusting objects ; little 
hobgoblins of all possible shapes flying about the apartment, 
leering, hissing, threatening ; serpents, toads, rats, mice, 
and other loathsome reptiles and vermin, crawling over his 
bed or person, or running about his room ; creeping insects, 
which he appears busied in searching for among his clothes 
or the bed covering. There is no end to the number or 
diversity of these hallucinations in different individuals. 

But with all this variety in the objects of delusion, there 
is one striking feature of the delirium which is seldom want- 
ing. The patient is almost always fearful, and usually has 
some special object of terror, which influences most of his 
movements. 

Very often the manner of the patient is quiet and gentle. 
He recognizes persons about him, receives his physician 
courteously, answers his questions without hesitation, and, 
if his attention is roused and strongly fixed, will give quite 
rational answers upon all points except such as are connected 
with his hallucinations. 

Morbid, vigilance is one of the most prominent and char- 
acteristic symptoms. The disease begins with broken and 
disturbed rest, becomes confirmed with the occurrence of 
obstinate wakefulness, and ends when the patient is enabled 
to sleep profoundly. It frequently happens that not a wink 
of sleep is obtained for several days, and it is said some- 
times not for one or even two weeks. 

At the end of three or four days, though sometimes as 
late as a week, or later, if no untoward event happens, the 
patient generally falls into a sound sleep, which may con- 
tinue for twelve, eighteen, twenty-four, and, it is said, even 
for thirty-six hours. From this he awakes, feeble, pale, and 
trembling, but free from his illusions, and, generally, dis- 
posed to eat. Convalescence has now commenced, and 
though some delirious symptoms may occasionally linger or 
recur for a day or two, they gradually disappear entirely, 
and the patient is restored to health. Not unfrequently 
the first sleep is only for a few hours, and is followed by an 



702 FUNCTIONAL DERANGEMENTS. 

amelioration of the symptoms, which subsequently disappear 
upon a return of rest. 

Instead, however, of this favorable course, cases impro- 
perly treated, or without any treatment, sometimes lapse into 
what may be called the third stage, which is characterized 
by great prostration. The delirium is now complete ; the 
previous illusions give way to incoherence ; extreme rest- 
lessness takes'place, so that it is necessary often to confine 
the patient forcibly to his bed ; the tremors are excessive ; 
the pulse is extremely frequent and feeble ; cold or warm 
sweats cover the surface ; the features are sunken and hag- 
gard ; the tongue is brown and dry ; the pupils are either 
much contracted or dilated ; and subsultus tendinum, mut- 
tering delirium, coma, and convulsions, precede death. 

Simple, uncomplicated delirium tremens is not a danger- 
ous disease. It generally subsides spontaneously, and, under 
proper treatment, almost always ends favorably. The chief 
danger is of death from debility, and especially from ex- 
haustion after muscular exertion; and, if this be guarded 
against, there is little else to apprehend. Sometimes, also, 
the patient destroys himself, but very rarely with suicidal 
intention. 

But when the disease is complicated with cerebral inflam- 
mation, or a high degree of active cerebral congestion, when 
it supervenes upon a severe injury, or occurs in the course 
of another serious disease, it adds no little to the danger ; 
and such cases not unfrequently end in death. Stupor, 
convulsions, complete incoherence, muttering, subsultus, ex- 
treme frequency of pulse, a dry tongue, and a cold, clammy 
surface, are unfavorable signs. 

Very few die of the earlier attacks. Each successive 
one becomes more dangerous, because usually occurring in 
a more debilitated constitution, and associated with a greater 
amount of organic disease. Yet some individuals recover 
from very numerous attacks, and die at last either of some 
accidental disease, or of the complicated organic derange- 
ments resulting from intemperance, independently of the 
delirium. 



PARALYSIS. 703 

Treatment. — According to the view here taken of the 
pathology of delirium tremens, the indications of treatment 
are clearly, first, to stimulate the brain up to the point essen- 
tial to its correct action; and, secondly, after having thus 
reinstated it in its normal functions, to withdraw gradually 
the artificial support, and bring the organ safely back to a 
reliance upon the ordinary healthy influences. In almost 
air uncomplicated cases, these objects can be accomplished 
without difficulty, provided the treatment has not been post- 
poned so long that the system has sunk below the point of 
impressibility. Nothing in the range of our experience will 
do this so certainly, and with so little danger, as the comp. 
syrup of valerian, or fever syrup. But it must be given in 
decided doses. We have often given as much as two ounces 
at once, with the happy result of a complete suspension of 
the disease in half an hour. Nothing else has been found 
necessary, except that in bad cases we apply the chloroform 
liniment freely to the spine and epigastrium. 

PARALYSIS. 

General Observations. — By paralysis, or palsy, is meant a 
total or partial loss of sensibility or motion, or of both, in 
one or more parts of the body. All paralytic affections 
may be divided into two classes : the first including those 
in which both motion and sensibility are affected ; the 
second, those in which the one or the other only is lost or 
diminished. The former is called perfect, the latter imper- 
fect paralysis. Again, the paralysis may be general or par- 
tial, as it affects the whole body or only a portion of it. 
Partial paralysis is divided into hemiplegia, when it is lim- 
ited to the lateral half, and paraplegia, when it is confined 
to the inferior half of the body. The term local paralysis 
is used when only a small portion of the body is affected, 
as the face, a limb, a foot, etc. 

There are also certain forms of paralysis arising from the 
use of metallic poisons, as mercurial palsy, and saturnine or 
lead palsy ; and lastly, there is a peculiar affection known 
as paralysis agitans, or shaking palsy. 
45 



704 FUNCTIONAL DERANGEMENTS. 



GENERAL PARALYSIS. 

General paralysis, or complete loss of sensation and mo- 
tion of the whole system, cannot take place without death 
immediately resulting ; but this term is usually applied to 
palsy affecting the four extremities, whether any of the 
other parts of the body are implicated 'or not. It must not 
be confounded with the general paralysis of the insane. In 
most cases the loss of motion is more marked than that of 
sensibility ; the intelligence also soon becomes affected. 

HEMIPLEGIA. 

This term is used to denote paralysis of one side, extend- 
ing generally to both the upper and lower extremities. It 
is the most common form of palsy ; the left suffers more 
frequently than the right side. When only one extremity 
suffers, it is generally the arm. Very rarely, the upper 
limb of one side and the lower of the opposite is affected, 
forming what is termed transverse or crossed palsy. Gene- 
rally the paralysis extends to the side of the face, the angle 
of the mouth being drawn slightly upwards and to the sound 
side, clearly because the muscles on that side are no longer 
counteracted and balanced by the corresponding muscles on 
the paralyzed side. The tongue also is often affected ; 
when protruded, its point is turned towards the palsied side, 
owing to the muscles which protrude this organ being pow- 
erless on that side and in full vigor on the other, so that the 
sound half of the tongue is pushed out farther than the 
other half, and consequently it bends towards the affected 
side. The paralysis is always limited to one-half of the 
body, the median line being the boundary. In most cases 
there is ansesthesia, [loss of sensibility.] The mental fac- 
ulties are sometimes uninjured, but more frequently are 
irreparably damaged. The memory especially becomes af- 
fected ; at the same time there is a peculiar tendency to 
shed tears, and to be much affected by slight causes. 

If recovery take place, the symptoms of amendment are 
first noticed in the leg. In hopeless cases the limbs waste ; 
their nutrition is diminished ; they become atrophied. It 



PARALYSIS. 705 

is of practical importance to remember that they are colder, 
and unable to resist the influence of cold or heat equally 
with the sound parts. 

Hemiplegia is generally the result of organic lesions of 
the brain. It may be transient, and caused by a fit of epi- 
lepsy ; or it may follow chorea ; or an imperfect form may 
occur in nervous women, (hysterical hemiplegia.) In all 
forms the paralysis of motion is the prominent symptom; 
but sensation is generally impaired. 

PARAPLEGIA. 

Paraplegia, or paralysis of the inferior half of the body, 
most frequently commences slowly and insidiously, with 
weakness and numbness of the feet and legs, or with ting- 
ling, formication, of these parts, unattended by pain. By 
degrees the weakness increases, until there is complete loss 
of sensibility and motion in the lower extremities, with 
paralysis of the bladder and rectum ; the patient is obliged 
to remain in the horizontal posture ; sloughs form on the 
hips and sacrum ; and these, by their irritation and exhaust- 
ing discharges, accelerate death. If the urine be allowed 
to collect in the bladder in any quantity, it will become 
ropy, fetid, and alkaline ; owing probably to the coats of 
the bladder becoming diseased and pouring forth unhealthy 
mucus, in consequence of the paralysis. 

Although voluntary motion is completely abolished in the 
lower limbs, involuntary movements and spasms of the 
muscles are not uncommon. Reflex movements can be 
excited much more frequently in paraplegia than in hemi- 
plegia. 

Paraplegia may arise from injury of the spinal cord or 
its membranes ; from inflammation or other diseases of these 
parts ; from tumors pressing upon the cord ; as well as from 
affections of the bones and cartilages of the vertebral col- 
umn. There seems reason to believe, also, that some cases 
may be merely functional ; that is to say, that no organic 
change exists which we can recognize. Intemperance, cold, 
excessive venery, etc., seem to produce this form. 



706 FUNCTIONAL DERANGEMENTS. 



LOCAL PARALYSIS. 

Of the different varieties of local palsy, I shall only 
mention paralysis of the face. As one-half only of the face 
is affected, the appearance is very striking, the features on 
the paralyzed side being blank, unmeaning, and void of all 
expression. It is generally free from danger, being but 
rarely connected with cerebral disease ; exposure to cold is 
a frequent cause of it. 

MERCURIAL PALSY. 

Mercurial palsy, or mercurial tremor, as it is sometimes 
termed, consists of a kind of convulsive agitation of the 
voluntary muscles, which is increased when volition is 
brought to bear upon them. . In advanced stages of the dis- 
ease, articulation, mastication, and locomotion are performed 
with difficulty; while the use of the hands is almost 
entirely lost. The skin acquires a brown hue, and the 
teeth turn black. Workmen exposed to the fumes of mer- 
cury, such as gilders of buttons, glass-platers, barometer- 
makers, etc., are very liable to it. 

LEAD PALSY. 

This affection usually follows or accompanies colica pic- 
tonum, though it may exist independently. The poison of 
lead appears to exert some peculiar noxious influence over 
the nerves of the forearm and hand ; in consequence of 
which the -'extensor muscles of the hands and fingers 
become paralyzed, so that when the arms are stretched out 
the hands hang down by their own weight, or, as the 
patients say, the wrists drop. The inferior extremities are 
very rarely affected. The sufferers frequently experience 
attacks of lead colic. A characteristic symptom of the 
presence of lead in the system is the existence of a blue or 
purplish line — the sulphuret of lead — round the edges of 
the gums, just where they join the teeth; a very im- 
portant aid to diagnosis, for the notice of which we are 
indebted to Dr. Burton. Plumbers, painters, color-grinders, 



PARALYSIS. 707 

type-founders, etc., are the usual sufferers from this affec- 
tion. 

PARALYSIS AGITANS, OR SHAKING PALSY. 

This disease is characterized by a tremulous agitation — 
a continued shaking — usually commencing in the hands and 
arms, or in the head, and gradually extending over the 
whole body. The disease progresses slowly, but when far 
advanced the agitation is often so violent as to prevent 
sleep ; the patient cannot carry food to his mouth ; degluti- 
tion and mastication are performed with difficulty ; the 
body is bent forward, and the chin bent on the sternum ; 
the urine and faeces pass involuntarily ; and coma with slight 
delirium closes the scene. Many cases, however, remain 
stationary during the remainder of the patient's life, except 
that the disease is worse at some times than at others. 

Treatment of Paralysis. — As paralysis is only the effect 
of some morbid lesion in one or other of the nervous centres, 
our treatment must be directed to the pathological condition 
on which it depends. 

In hemiplegia, even when seen early, it must not be 
forgotten that the mischief is done ; and we cannot remedy 
it by taking away blood. Indeed, the patient will require 
all the power which he possesses to enable him to recover 
from the shock to his system; and hence depletion will 
only do harm. Benefit may, however, be expected 'from 
active cathartics, particularly such as jalap and scammony 
combined with calomel, or croton oil, or stimulating purga- 
tive enemata. Some authors recommend blisters to the 
scalp or to the nape of the neck, or the use of a seton. I 
should also try alterative doses of mercury, with iodide of 
potassium, etc. When the paralysis becomes chronic, 
stimulants, especially such as act on the paralyzed parts, 
must be had recourse to. Strychnia in small doses (the 
twentieth or thirtieth part of a grain thrice daily) may be 
cautiously tried, if we can reasonably hope that there is no 
disease of the brain. Or local stimulants may be employed ; 
thus frictions with the hand or flesh-brush, and stimulating 
liniments of turpentine, ammonia, tincture of cantharides, 



708 FUNCTIONAL DEBANGEMENTS. 

croton oil, etc., have been used with occasional benefit. 
Electricity and galvanism have also been extensively em- 
ployed, but when there is structural disorganization they 
undoubtedly do harm. 

The same principles apply to the treatment of paraplegia, 
arising from disease of the cord or its covering. In many 
of these cases, however, a mercurial course does decided 
good. The iodide of potassium, with liquor potassse and 
sarsaparilla, will also be useful. Where the paralysis 
seems to depend upon serous effusion into the spinal cavity, 
Dr. Seymour recommends the tincture of cantharides in 
half-drachm doses. Embrocations may also be applied along 
the spine. 

In mercurial palsy the patient must be withdrawn from 
the injurious atmosphere. Warm baths, good diet, sea-air, 
and iodide of potassium — for reasons to be presently men- 
tioned — will generally effect a cure. 

The treatment of lead palsy has been very much facili- 
tated by the hypothesis promulgated by M. Melsens, that 
the effects of lead and mercury were caused by chemical 
combination with the tissues of the body, or by being 
present in intimate union with those tissues in some analo- 
gous manner. The therapeutical application of the theory 
necessarily was, as pointed out by Dr. J. R. Nicholson, that 
the action of the curative agent must be directed to the 
conversion of the poisonous metal into a compound having 
less affinity for those tissues, and therefore readily elimi- 
nated from the body ; and it has been shown that iodide of 
potassium possesses the requisite conditions to become a 
curative agent in lead diseases, according to this theory. 

Dr. Nicholson has published a very interesting case in 
which the lead, after the administration of the iodide of 
potassium, could be readily detected in the urine, notwith- 
standing it could not be found before the commencement of 
the treatment; but though the colic had entirely ceased, 
the palsy persisted. Galvanism was then used in conjunc- 
tion with the iodide of potassium, and the patient went to 
his work about fifty days after the commencement of the 
treatment without any trace of paralysis. From this case 



EPILEPSY. 709 

it is concluded : First, that the iodide of potassium acts 
as a curative agent in lead-poisoning, b}^ converting the 
lead into a form which can again be readily taken up by 
the blood, and evacuated by one of the natural outlets ; 
secondly, that the iodide acts more speedily in conjunction 
with galvanism, when employed for the relief of lead para- 
lysis. 

In addition to the iodide of potassium — gr. v. thrice daily 
— the patient may use warm baths, friction to the paralyzed 
limb, and exercise in the fresh air. To prevent this dis- 
ease, Liebig recommends all workers in lead to drink daily 
sulphuric acid lemonade. This acts probably by converting 
the salt of lead, as it enters the system, into an insoluble 
sulphate. 

As regards the cure of paralysis agitans, I can say but 
little, since I know of no measures likely to do much good. 
I should, however, try the effects of pure air, nourishing 
diet, baths, ferruginous tonics, and occasional opiates. 

EPILEPSY. 

Epilepsy is a disease the leading symptoms of which 
are — sudden loss of consciousness and sensibility, with 
clonic spasm, usually followed by coma ; the attack recur- 
ring at intervals. 

Warnings. — There are sometimes, though not in the 
majority of cases, premonitory symptoms sufficient to warn 
the patient of an approaching seizure. These warnings 
differ both in duration and character ; in some cases being 
too short to allow the sufferer to dismount from horseback, 
or to get away from the fire, or even to lie down ; while in 
other instances, many minutes, or even hours, elapse 
between their occurrence and the attack. Spectral illu- 
sions, headache, giddiness, dimness of vision, confusion of 
thought, and especially that peculiar sensation known as 
the aura epileptica, constitute the most frequent premonitory! 
symptoms. The epileptic aura is differently compared by 
patients to a stream of cold water, or a current of cold or 
warm air, or the creeping of an insect ; the sensation com- 



710 FUNCTIONAL DERANGEMENTS. 

mencing at the extremity of a limb, and gradually ascend 
ing along the skin towards the head ; and when it stops, the 
paroxysm taking place. 

Symptoms. — The commencement of the seizure is gene- 
rally characterized by the utterance of a loud, piercing 
shriek or scream, immediately after which the individual 
falls to the ground senseless and violently convulsed. 
Hence the disease has been called by the vulgar the falling 
sickness, or, more vaguely, fits. During the attack the 
convulsive movements continue violent ; there is gnashing 
of the teeth, foaming at the mouth, the tongue is thrust 
forward and often severely bitten, the eyes are fixed and 
partly open, the breathing is laborious or almost suspended, 
the face flushed and turgid, and death, in fact, seems about 
to take place from suffocation; when, gradually, these 
alarming phenomena subside, and shortly afterwards cease, 
leaving the epileptic insensible, and apparently in a sound 
sleep, or state of coma, from which he recovers exhausted, 
but without any knowledge of what he has just gone 
through. 

The average duration of the fit is about five or eight 
minutes ; it may last for half an hour or more. It may 
also be very slight or very severe. The periods at which 
the seizures recur are variable. At first there is often an 
interval of two or three months, but as the disease pro- 
gresses the intervals become shorter, until hardly a day 
passes without one or more paroxysms. In recent cases, 
especially, the fits often take place in the night, either on 
just going to sleep or on awaking. As may be imagined, 
various accidents are likely to occur from falls, etc., during 
the attack. 

Causes. — The tendency to epilepsy is often hereditary. 
Malformations of the head are frequent predisposing causes. 
When an epileptic dies who has only labored under the 
disease for a short time, no appreciable lesion of any part 
of the nervous system can, as a rule, be discovered. If 
death occur during a paroxysm, the brain is often found 
more or less congested. In cases of long standing, disease 



EPILEPSY. 711 

of the cerebral blood-vessels, with softening or induration 
of the brain, may be found. Occasionally the bones of the 
skull are thickened or otherwise diseased. 

Treatment. — This must have reference to the measures to 
be adopted during a fit, and those to be employed in the 
interval. 

During the fit. — The patient should be laid on a large 
bed, air freely admitted around him, his head raised, and 
his neckcloth, together with any tight parts of his dress, 
loosened. A piece of cork or soft wood should, if possible, 
be introduced between his teeth, to prevent injury to the 
tongue. Cold affusion to the head will sometimes be useful, 
especially if the countenance is turgid and congested. In 
cases preceded by the epileptic aura, the application of a 
ligature just above the part where the sensation is expe- 
rienced, has been said to prevent the attack. 

In the interval. — We must endeavor to improve the 
patient's general health, and especially to give tone and 
firmness to the nervous system. Every thing tending to 
depress the vital powers does harm. Mineral tonics, espe- 
cially the salts of iron, zinc, and silver, are consequently to 
be employed. The cold shower-bath may be especially 
recommended, if it can be well borne ; otherwise the tepid 
sponging bath should be substituted. The diet must be 
simple but nutritious, avoiding intoxicating drinks, and the 
patient's habits must also be regulated by such rules as 
common sense will dictate — daily exercise, early hours, and 
attention to the alvine and urinary secretions being neces- 
sary, while mental excitement or exertion is, on the other 
hand, especially contra-indicated. 

In some cases, those more particularly which are 
dependent upon the thickening of the cranial bones, iodide 
of potassium, or a gentle, long-continued course of mercury, 
does good. Fovill had great faith in the oil of turpentine 
in half-drachm doses, repeated every six hours ; care is 
required, however, lest strangury result from its use. The 
nitrate of silver long enjoyed great but undeserved reputa- 
tion; its tendency to blacken the skin, moreover, is suffi- 
cient to interdict its employment. I have used the vapor 



712 FUNCTIONAL DERANGEMENTS. 

of chloroform, and believe that I have found the fits 
diminish both in severity and number from its employment. 
The truth probably is, however, that epileptics often im- 
prove for a time under every new plan of treatment. 

HYSTERIA. 

Dr. Copeland defines hysteria as, "Nervous disorder, 
often assuming the most varied forms, but commonly pre- 
senting a paroxysmal character, the attacks usually com- 
mencing with a flow of limpid urine, with uneasiness or 
irregular motions and rumbling noises in the left iliac region, 
or the sensation of a ball {globus hystericus) rising upwards 
to the throat, frequently attended by a feeling of suffocation, 
and sometimes with convulsions ; chiefly affecting females 
from the period of puberty to the decline of life, and prin- 
cipally those possessing great susceptibility of the nervous 
system, and of mental emotion." 

I shall consider this disease as it occurs in paroxysms, 
and as it mimics other affections. 

Symptoms. — The symptoms which characterize the hys- 
teric paroxysm or fit are convulsive movements of the trunk 
and limbs ; violent beating of the breasts with the hands 
clenched, or tearing of the hair or of the garments ; shrieks 
and screams ; violent agitation ; and the globus hystericus ; 
the attack ending with tears, convulsive fits of crying or 
laughter, and sometimes with violent hiccup. Occasionally 
the patient sinks to the ground insensible and exhausted, 
remains so for a short time, and then recovers, tired and 
crying. The fit is often followed by the expulsion of a 
quantity of limpid urine ; occasionally this secretion is passed 
involuntarily during the paroxysm. 

Diagnosis. — It differs from epilepsy, inasmuch as the fit 
is almost peculiar to women ; it continues longer ; there is 
seldom loss of consciousness, the patient being aware of all 
that is passing around her. The convulsive movements are 
of a different character, much less severe, not more marked 
on one side of the body than the other ; the respirations are 
never suspended ; the tongue is not bitten ; and the attack 
is not followed by coma, as epilepsy is. 



HYSTERIA. 713 

Hysteria simulates almost all diseases ; perhaps the 
favorite maladies imitated are, suppression of urine, calculus 
of the bladder, inflammation of the peritoneum, pleurisy, 
consumption, laryngitis, stricture of the oesophagus, aphonia, 
or loss of voice, paralysis, and disease of the spine or of 
one or more of the joints. A practiced eye is seldom, how- 
ever, deceived by such patients. There is a peculiar ex- 
pression about hysterical women, impossible almost to define, 
yet readily recognized when once it has been studied ; they 
answer questions in an unpleasant manner, often only in 
monosyllables ; and their pains are always said to be most 
acute, and to be increased by pressure, or almost even by 
pretended pressure. The catamenia are generally irregular, 
and there is often profuse leucorrhcea. 

Treatment. — During a fit, the patient's dress should be 
loosened; she should be prevented from injuring herself; 
should be surrounded by cool air; smelling-salts may be 
applied to the nostrils ; and, if she can swallow, a draught 
containing a drachm of the compound tincture of valerian, 
or of the fetid spirit of ammonia, should be administered. 
If the paroxysm continues, the sudden and free application 
of cold water to the head and face will probably cut it 
short. 

In the other forms of hysteria, the general health must 
be attended to, the bowels kept freely open, the shower-bath 
daily used, and tonics administered. When the menses are 
unnatural, the treatment must have reference to the nature 
of the particular disorder ; thus, if too abundant, astringents 
and the cold hip-bath, to which alum should be added, must 
be employed ; if scanty, they should be encouraged by aloetic 
purgatives, different preparations of iron, and the warm bath. 
The compound syrup of butternut (see Dyspepsia) will 
often fulfill every indication in the treatment of hysteria. 

The patient's diet should be regulated; hot rooms and 
evening parties proscribed; stays ought not to be worn; 
and, lastly, it is of the greatest importance that healthy 
mental occupation should be found. Indeed, without this 
a cure is not to be expected. 



714 FUNCTIONAL DERANGEMENTS. 



CHAPTER VII. 

FUNCTIONAL DISEASES OF THE SPINAL MARROW. 



CHOREA, OR ST. VITUS's DANCE. 

Chorea, or St. Vitus's dance, is characterized by incom- 
plete control of the muscles of voluntary motion by the will, 
giving rise to irregular, tremulous, and often ludicrous ac- 
tions. It has been quaintly designated "insanity of the 
muscles." 

Symptoms. — This disease occurs most frequently in young 
girls between the age of six and fifteen, and begins generally 
with twitchings of the muscles of the face. By degrees, 
all or almost all the voluntary muscles become affected ; the 
child finds it impossible to keep quiet ; there is a constant 
movement of the hands and arms, and even of the legs ; 
one side of the body is generally more affected than the 
other; the features are most curiously twisted and contorted; 
the articulation is impeded ; and these movements are always 
most severe when the child is watched. If you ask your 
patient to put out her tongue, she is unable to do so for 
some moments, but at last suddenly thrusts it out, and as 
suddenly withdraws it. If you tell her to walk, she ad- 
vances in a jumping manner, by fits and starts, dragging 
her leg rather than lifting it, and alternately halting and 
hopping. She cannot even sit still; her shoulders writhe 
about, she picks her dress, and shuffles and scrapes the floor 
with her feet. During sleep, these irregular actions usually 
cease. When the disease lasts long, the countenance assumes 
a vacant appearance bordering on fatuity, and some imbe- 
cility of mind becomes manifest. 

Chorea may last from one week to several months ; the 
average duration is probably five or six weeks. It is often 
complicated with hysteria; and it has been observed to 



DERANGEMENTS OF THE SPINAL MARROW. 715 

happen in conjunction with, or on the termination of, rheu- 
matic fever, and rheumatic inflammation of the heart. 
Although most common in girls, yet boys not unfrequently 
suffer from it. , 

The treatment consists in regulating the bowels, subduing 
irritation, and strengthening the system. For this purpose, 
the employment of cathartics of a stimulating nature is 
necessary, such as calomel and jalap, or, where worms are 
suspected, the oil of turpentine. A combination of tonic 
or antispasmodic medicines with purgatives, is often found 
to be serviceable. The two great remedies, however, are 
the cold shower, or douche bath, and iron. As regards the 
former, it should be employed every morning on the 
patient's rising ; with respect to the latter, different prepara- 
tions have been recommended. Perhaps the best is the 
carbonate of iron, given in doses varying from half a drachm 
to two drachms, mixed with molasses. The sulphate or 
the tincture of iron may, however, be used almost as advan- 
tageously. The diet must be nutritious, exercise in the 
fresh air freely allowed, and mental excitement guarded 
against. 

FUNCTIONAL DERANGEMENTS OF THE SPINAL MARROW. 

When it is considered that from the spinal centres pro- 
bably flows an influence which is requisite to sustain the 
various organic functions in their healthy condition, it can 
be readily understood that a great diversity of derange- 
ment in these functions may result from deficient, excessive, 
or perverted action in the centres, without the necessary 
existence of any organic disease. It is, indeed, highly 
probable that many disorders of the digestive, respiratory, 
and circulatory organs, many derangements of the secretory 
and nutritive processes, of which the causes are obscure, 
might be traced to the spinal marrow as their source, had 
we the means of investigating accurately the functional 
disorders of that structure. But, in the present state of 
our knowledge, such a reference must be conjectural, 
except in those cases in which some direct evidence exists 
of spinal disturbance. Still, even a conjectural reference 



716 FUNCTIONAL DERANGEMENTS, 

may lead to useful results; and remedies may often be 
advantageously addressed to the spine, when no other proof 
of disorder in the cord is offered than morbid phenomena 
of the organs over which it presides. It is, indeed, a good 
practical rule, in all those cases of functional disease in any 
part of the body supplied with spinal nerves, of which the 
cause is obscure, to bear in mind their possible origin in 
the medulla spinalis, and to be prepared, should other 
measures fail, to have recourse to such as may be calculated 
especially to alter the condition of that portion of the 
nervous system. 

But, while it is probable that much disorder may depend 
on the spinal marrow, which cannot be clearly traced to it, 
there are numerous instances in which that structure affords 
direct evidence of a diseased condition, and thus enables us 
to refer various morbid phenomena existing elsewhere, with 
great confidence, to their true origin. The evidence of 
functional spinal disorder above alluded to is that offered 
by tenderness upon pressure on the spinous processes, when 
there is no reason to suspect the existence of spinal menin- 
gitis or myelitis. This symptom has been so frequently 
found associated with various disorders in different parts of 
the system, which have yielded to remedies addressed to 
the seat of it, that it has come to be regarded as the cha- 
racteristic sign of a peculiar affection, which for want of a 
better name is generally denominated spinal irritation. The 
remainder of this article will be devoted especially to the 
consideration of that affection. 

SPINAL IRRITATION. 

Symptoms. — These are immensely diversified. They are, 
indeed, almost as numerous as the possible derangements 
of function in all parts of the body, supplied with nerves 
from the spinal marrow. The only symptom common to all 
the cases is the tenderness on pressure. Upon making 
pressure on the spinous processes, beginning at the neck 
and proceeding downward, we may find either a general 
tenderness along the whole or the greater portion of the 
column, or, what is much more common, it may be confined 



SPINAL IRRITATION. 717 

to one or a very few of the vertebrae ; and, not unfrequently, 
one is more acutely sensitive, while above and below the 
tenderness gradually diminishes until it ceases to be evident. 
The dorsal vertebrae are most frequently affected. There 
is not less difference in the degree of tenderness than in its 
precise seat. In some instances it is slight, requiring 
rather heavy pressure to develop it ; in others it is exqui- 
sitely keen, so that a touch produces uneasiness, and the 
slightest pressure occasions intolerable pain. A remarkable 
circumstance is, that in the greater number of cases there 
is little or no pain in the affected portion of the spine 
except when pressure is made, so that the real seat of 
disease might escape notice were not attention directed 
towards it by symptoms existing elsewhere. 

I shall not pretend to enumerate all these symptoms, but 
shall content myself with calling attention to some of the 
more prominent. They vary with the portion of the spine 
affected ; those parts especially showing signs of disorder 
which receive nerves directly or indirectly from the vicinity 
of the tender vertebrae. 

There is scarcely a single morbid sensation or perversion 
of function occurring in any part of the body beneath the 
head which may not originate in spinal irritation ; and in 
all cases in which the cause of any existing disorder of this 
kind is obscure, it should be sought for in the spine. 

The affection not unfrequently attends other diseases. 
It is very common in hysteria, so much so as to be almost 
characteristic of that complaint. It also occasionally 
attends chorea and epilepsy. There is reason to believe 
that some cases resembling tetanus and hydrophobia, and 
which have been mistaken for these complaints, have 
depended upon this kind of spinal irritation. 

Causes. — These are not well understood. The disease 
occurs most frequently in women, and especially during the 
menstrual period, or between the ages of fourteen and forty- 
five. It would seem, therefore, to have some connection 
with the uterus ; but such a connection is certainly not 
essential, for the disease often occurs in children and in 
men. Spinal distortion seems also to constitute a predis- 



718 FUNCTIONAL DEKANGEMENTS. 

position. Of the exciting causes, changes in the weather 
are probably among the most frequent. Mental disturbance 
appears to be capable of inducing it, and perhaps any other 
cause calculated strongly to impress the nervous system. 

Treatment. — If the disease is recent, nothing more will 
commonly be necessary than an application of the chloroform 
liniment to the part affected ; if bathing with it should not 
prove sufficient, a flannel should be saturated with it, and 
applied to the part most affected. In cases of long standing 
it is often necessary to blister repeatedly with Spanish 
flies. The internal treatment should be the same as for 
dyspepsia. 

TETANUS LOCKED JAW. 

Tetanus is a disease in which the muscles are in a state 
of rigid lasting contraction, with paroxysms of brief and 
painful spasm, alternating with irregular intervals of more 
or less complete relaxation, without coma, or any essential 
disturbance of the mental faculties. 

Different names have been conferred upon the tetanic 
condition, according to the obvious effects of the spasm. 
Thus, when it produces a closure of the jaws, the affection 
has been denominated trismus ; when a curvature of the 
body backward, opisthotonos; when forward, emprostho- 
tonos ; when to one side, pleurosthotonos. These conditions 
are now T treated as "mere symptomatic diversities of the 
same disease. 

Tetanus has been divided into the idiopathic and symp- 
tomatic : the former, independent of any other known 
pathological condition ; the latter, produced by some other 
distinct affection existing within or without the spine. The 
symptomatic variety, when originating in wounds or other 
external injury, is called traumatic tetanus. This latter 
name, as embracing cases of very frequent occurrence, of a 
certain identity of origin, and peculiar violence of character, 
is very convenient, and almost universally employed. As 
to the disease from other sources, there is always much 
uncertainty ; some ascribing it to one condition, others to 
another, and all acknowledging its obscurity; there is a 



TETANUS. 719 

propriety in adopting some designation which, whether. in 
itself correct or incorrect, may be generally received and 
understood. Most writers at present include under the 
title of idiopathic tetanus all cases not traumatic, whether 
strictly independent, or symptomatic of some other affec- 
tion ; and their example is followed in this work. 

Symptoms, Course, etc. — The first signs of a commencing 
attack are commonly feelings of uneasiness and stiffness in 
the back of the neck ; an unusual rigidity about the jaws, 
with some pain in attempting to open the mouth widely ; 
and occasionally a disagreeable sensation in the throat, and 
slight embarrassment in swallowing. There is also fre- 
quently uneasiness in the epigastrium, which soon amounts 
to acute pain, shooting from the pit of the stomach towards 
the spine, and attended with a sensation of stricture or 
dragging, dependent, no doubt, upon spasm of the diaphragm. 
Other muscles become quickly involved, especially those of 
the face and trunk ; the disease then extends to the limbs ; 
and ultimately almost all the voluntary muscles of the body 
are more or less affected. 

There- is a permanent rigidity or tonic spasm of the 
muscles, which exists in various degrees throughout the 
complaint, seldom undergoing complete relaxation. Slight 
at the commencement, it increases with the advance of the 
disease, and, when this is fully formed, imparts a degree of 
hardness to the muscles almost like that of a board. But 
besides this state of permanent rigidity, there are paroxysms 
of spasms approaching to the clonic character, which are 
much shorter, but proportionably more violent, and alter- 
nate with periods of comparative relaxation. These 
paroxysms are at first slight, and at somewhat distant 
intervals ; but gradually increase in frequency and violence, 
until at length they occur every ten or fifteen minutes, or 
even more frequently, so that the patient is scarcely out of 
one before he falls into another; and their force is such 
that they sometimes throw the whole body about in different 
directions, and endanger injury from this cause. 

The slightest causes are often sufficient to induce a 
46 



720 FUNCTIONAL DERANGEMENTS. 

paroxysm, such as an attempt to speak or to swallow, any 
sudden noise, a draught of cold air, etc. 

Causes. — A peculiar predisposition is probably requisite, 
in general, to the production of tetanus, as comparatively 
few are attacked of those exposed to the exciting causes, 
though these may be to all appearance similar. In what 
this predisposition consists is unknown. That a long-con- 
tinued prevalence of heat favors its production is highly 
probable ; for the disease is incomparably more frequent 
between the tropics than in cold or temperate latitudes ; 
and, in varying climates, is more apt to occur during the 
hot than the cold seasons. 

It has been supposed that a depraved state of health, re- 
sulting from bad diet, vitiated air, and a residence in low, 
damp situations, sometimes constitutes a predisposition; 
and yet the traumatic form of the disease often occurs in 
the young, robust, and vigorous. 

Males are much more frequently and severely affected 
than females. This, no doubt, arises in part from the much 
greater exposure of the former to wounds and other excit- 
ing causes ; yet there is probably a constitutional difference 
in the two sexes, in relation to nervous disease, correspond- 
ing in some measure with their respective physical energies ; 
women being more liable to the mild affections of hysteria 
and chorea, while men suffer more from apoplexy and te- 
tanus. 

Persons are most subject to the disease between the ages 
of ten and fifty ; but no age is exempt. It is rare in ad- 
vanced life. As already stated, infants soon after birth 
often suffer from it. 

It appears to be a well-ascertained fact that the negro is 
more disposed to tetanus than the white. Some have 
ascribed the difference to the greater exposure and worse 
living of the former ; but, under apparently the same cir- 
cumstances, negroes have appeared to suffer most. 

Of the exciting causes, incomparably the most frequent, 
in cold and temperate countries, are wounds or other kinds 
of external violence. Whether the wound is trifling or 



TETANUS. 721 

severe seems to be of little consequence. The slightest 
scratch will sometimes cause the disease, the most severe 
injury often fails to do so. As examples of the kind of 
wounds which have given rise to tetanus, may be mentioned 
those produced by needles in the fingers, a splinter under 
the nail, the extraction of a tooth, a fishbone in the fauces, 
the insertion of artificial teeth, the cutting of corns, running 
nails in the feet, the insertion of a seton, cupping, fractures 
and dislocations, contusing and lacerating bodies, and all 
kinds of surgical operations. It is believed that lacerated 
and punctured wounds are worse in this respect than 
smooth cuts, and injuries of the fingers, soles of the feet, 
and joints, than wounds elsewhere. The interval between 
the reception of the wound and the occurrence of tetanus 
is very uncertain. According to the statements of authors, 
it may be a few minutes, a few hours, several days, or even 
weeks. Most commonly the attack comes on between the 
fourth and fourteenth day after the injury. If it should 
not supervene before the end of three weeks, the patient 
may be considered safe. The longer the interval, the milder 
generally is the attack said to be, and the more likely to 
end in recovery. The disease is thought to occur less fre- 
quently than formerly, in consequence of the greater care 
extended to the wounded, and the greater skill exhibited in 
their treatment. Soldiers wounded in battle are said to be 
more apt to suffer than those wounded in civil life, because 
so often exposed to cold, wet, and privations, after their 
injuries, and often so badly cared for from the want of suit- 
able surgical assistance. 

Other local irritation besides that of wounds may occasion 
the disease. Thus, it is thought to have arisen from swol- 
len gums, ulcers, intestinal worms, calculi in the bladder, 
etc. Violent mental emotion, especially terror, has been 
accused of producing tetanus ; and Dr. Rush relates a case 
in which it was ascribed to harsh grating sounds. Strych- 
nine in poisonous quantities produces effects which cannot 
be distinguished from tetanus. But infinitely the most 
common cause of that variety of tetanus which is independ- 
ent of wounds, and is here denominated idiopathic, is expo- 



722 FUNCTIONAL DERANGEMENTS. 

sure to cold when the body has been hot and perspiring. 
Sleeping out upon the damp ground is a frequent cause of 
it ; and the use of a cold bath when perspiring, and of very 
cold water as a drink under similar circumstances, are said 
to have produced it. Exposure of this kind is the most 
frequent cause of the disease in tropical countries. It is 
apt to come on within a few hours after the exposure. 
When arising from this cause, the disease is more apt to be 
chronic and curable than when from wounds. The occur- 
rence of traumatic tetanus is much favored by the coopera- 
tion of cold, and other causes of irritation ; and it is probable 
that the two causes together may give rise to the disease, 
when neither separately would have been sufficient to pro- 
duce it. 

Prognosis. — Traumatic tetanus is exceedingly fatal. Some 
who have seen much of the disease assert that they have 
scarcely known of a case of recovery. The most successful 
report but a small proportion of cures. The journals, how- 
ever, teem with cases which have ended favorably under 
one or another kind of treatment ; and, though some allow- 
ance must be made for the probable idiopathic character of 
some of the cases considered as traumatic, yet there can be 
little doubt of the accuracy of the statements in the greater 
number; and sufficient encouragement is offered to the 
practitioner to persevere in an energetic use of means which 
he may consider as indicated. The means of determining 
the general ratio of cures are altogether wanting ; for it is 
not the custom to report unsuccessful cases. 

The idiopathic form of the disease is much less fatal ; 
and, as it occurs in temperate latitudes, is generally curable. 

It is highly probable that the milder cases of tetanus, 
whether traumatic or idiopathic, would sometimes end spon- 
taneously in health ; so that caution is always necessary, in 
judging of the effects of remedies, not to confound them 
with the workings of nature. 

Favorable circumstances are original mildness of the 
symptoms, complete relaxation between the spasmodic par- 
oxysms, the absence of any great embarrassment of the 
respiration, a natural state of the circulation, the occurrence 



TETANUS. 723 

of sleep under the influence of remedies, and the protraction 
of the case beyond the seventh day. Extreme severity of 
the paroxysms, uninterrupted rigidity of many of the mus- 
cles, great difficulty of deglutition and respiration, an appa- 
rent tendency to spasm of the glottis, insusceptibility to the 
action of powerful remedies, and a very feeble, frequent, 
and irregular pulse, are symptoms of very bad augury. 

Treatment. — One who depends upon authority alone would 
find extreme difficulty in coming to any satisfactory conclu- 
sion as to the treatment of this disease ; for occasional, and 
perhaps equal, success is claimed for apparently the most 
opposite plans of management ; and a very numerous list 
of remedies has been employed, each one of which is re- 
ported to have produced signal cures. But the fact appears 
to be that the disease occasionally gets well of itself, and 
the credit is given to some medicine, or combination of medi- 
cines, which may have been employed, though possibly with- 
out the least influence over the result. In my own experi- 
ence — and I have attended quite a number of cases, two- 
thirds of which got well — I have found nothing appear to be 
of much benefit except large doses of opium, and blisters 
to the spine. The opium should be given in such quantity 
as will prevent the spasms, and then repeated, so as to 
steadily keep the system under its influence for a number 
of days. The blister should be applied to the whole length 
of the spine ; and, after poulticing, the cuticle should be re- 
moved, and then kept running by applying cloths dipped in 
strong soapsuds. The bowels must be daily moved by cas- 
tor oil aided by large injections of soapsuds. Whenever 
the pulse is feeble, no matter what may be the stage of the 
disease, cordial medicines and nutritious food should be em- 
ployed. Wine and the different forms of ardent spirit, 
milk, animal broths, the yolk of egg, etc., should be freely 
used. Sulphate of quinia may be administered with the 
same view. 

In consequence of the closure of the jaws, there is occa- 
sionally some difficulty in introducing food ; but a vacancy 
can generally be found, either from the loss of a tooth, or 
behind the last teeth, large enough for the admission of 



IT 



24 FUNCTIONAL DERANGEMENTS. 



liquids. A greater difficulty is that often attendant upon 
deglutition. To obviate this, it may be necessary to inject 
food into the stomach through a tube, or to attempt to sup- 
ply the place of food by nutritious enemata. 

HYDROPHOBIA RABIES CANINE MADNESS. 

Hydrophobia is a peculiar disease, resulting from the en- 
trance into the system of the poison of a rabid animal. The 
poison is almost always received through a wound, generally 
the bite of the animal. This heals like any other wound, 
and for some time no peculiar or constitutional effects are 
experienced. It is seldom that the first symptoms of the 
disease make their appearance before the twentieth day after 
the injury. 

Symptoms, Course, etc. — The first warning of the approach- 
ing attack is frequently a feeling of pain in or near the seat 
of the wound, extending towards the trunk. If not acute 
pain, there is some unusual sensation, such as aching, ting- 
ling, burning, coldness, numbness, or stiffness in the cicatrix, 
which swells, becomes of a reddish or livid color, sometimes 
opens, and, if yet unhealed, assumes an unhealthy appear- 
ance, and discharges a thin, ichorous fluid instead of pus. 
Along with these local symptoms, some nervous disturbance 
is generally experienced; the patient becomes dejected, 
morose, irritable, restless ; light is disagreeable to him ; his 
sleep is troubled ; pains are felt in various parts of the body ; 
and signs of digestive disorder are not unfrequent. After 
the continuance of one or more of these preliminary symp- 
toms for a period varying from a few hours to five or six 
days, and sometimes without any of them, the patient be- 
comes sensible of a stiffness or stricture about the throat, 
and, in attempting to swallow, experiences some difficulty, 
especially in the deglutition of liquids. This may be con- 
sidered as the commencement of the attack. The difficulty 
of swallowing rapidly increases, and soon the act becomes 
impossible, unless with a resolute effort, exciting the most 
painful spasms in the fauces, and other indescribable sensa- 
tions, which appear to appall the patient, and cause him to 
dread the very thought of liquids. Singular nervous par- 



HYDROPHOBIA. 725 

oxysms come on. Sensations of stricture or oppression are 
felt about the throat and chest; the breathing is painful, 
embarrassed, interrupted with frequent sighs, or a peculiar 
kind of sobbing movement ; there is a sense as of impend- 
ing suffocation, and of necessity for fresh air ; shuddering 
tremors run through the whole frame, sometimes amounting 
almost to convulsions ; and a fearful expression of anxiety, 
terror, or despair is depicted on the countenance. The par- 
oxysms are brought on by the slightest causes, and are fre- 
quently associated with the attempt to swallow liquids, or 
with the recollection of the sufferings experienced in former 
attempts. Hence, any thing which suggests the idea of 
drinking to the patient will throw him into the most painful 
agitation and convulsive spasms. The sound of water 
poured from one vessel into another, the sight of liquids, or 
of objects which bring them to mind, as of the shining sur- 
face of a mirror, a current of cold air, or other cold substance 
touching the skin, may have this effect. 

Another characteristic feature of the disease is a copious 
secretion of a viscid mucus in the fauces, which the patient 
spits out with a sort of frantic vehemence and rapidity upon 
every thing around him, as if the idea of swallowing occa- 
sioned by the liquid induced this eager expulsion of it, lest 
a drop might pass down the throat. This, to a bystander, 
is sometimes one of the most striking phenomena of the 
case. 

Acute and, as it were, electric shocks of pain are now and 
then felt in the epigastrium, the back of the neck, and other 
parts of the spine. 

The mind is sometimes calm and collected in the intervals 
between the paroxysms, and generally the patient retains 
his consciousness ; but in most cases, there is at times more 
or less mental irregularity, and occasionally spells approach- 
ing to insanity come on, which are apparently beyond his 
control. Not unfrequently, he is aware of the approach of 
these spells, and, fearful of doing injury to those around 
him, begs that he may be restrained. The mental aberra- 
tion is often exhibited in groundless suspicion or apprehen- 
sion, which is expressed on the face and in the manner of 



726 FUNCTIONAL DERANGEMENTS. 

the patient. Sometimes, on the contrary, he takes a curious 
fancy to individuals, and lavishes on them marks of fond- 
ness and confidence. In comparatively rare instances, he 
gives way to a wild fury, like that of a savage beast when 
enraged ; roars, howls, curses, strikes at persons near him, 
rends or breaks every thing within his reach, bites others 
or himself; till, exhausted at length, he sinks into a gloomy, 
listless dejection, from which another paroxysm rouses him. 

The tongue is usually somewhat furred. There is often 
burning in the throat, with a thirst which cannot be grati- 
fied. Sometimes there is a feeling of hunger, sometimes of 
nausea with vomiting. The pulse is excited, sufficiently 
strong at first, but weaker as the complaint advances, and 
extremely feeble and frequent before its close. The skin 
is warm or natural in the beginning, but becomes cool in 
the end, and is often covered with a viscid and offensive 
sweat. Not unfrequently, paralytic symptoms come on 
before death. 

Remissions of the symptoms sometimes occur in the course 
of the complaint; during which the patient can drink, 
though with some difficulty, and can take food. Towards 
the close, such a remission is not uncommon, with an absence 
almost complete of the painful symptoms, so that the patient 
and the physician begin to entertain some hope. But if the 
pulse is now felt, it is found to be extremely feeble, and 
sometimes wanting. During this apparent relaxation of the 
disease, the patient occasionally falls into a sleep, from which 
he awakes only to die. The closing scene is marked by an 
excessively feeble or absent pulse, a cold skin, involuntary 
evacuations, and wandering or delirium; and death approaches 
either quietly, as a consequence of complete exhaustion, or 
in strong convulsions. 

The disease generally terminates between the second and 
fifth day, though it sometimes runs on to the seventh, eighth, 
or ninth. 

Causes. — There is one cause, and probably only one, of 
genuine hydrophobia. Some believe that the disease may 
originate in man independently of any poison from without ; 
but the cases are extremely rare in which this is supposed 



HYDROPHOBIA. 727 

to have occurred ; so much so as by their very rarity to ex- 
cite suspicion as to the accuracy with which they have been 
reported, or the soundness of the diagnosis. It is very 
certain that some of the symptoms of hydrophobia are 
imitated by spontaneous nervous disease. The difficulty 
of swallowing, and dread of fluids, have often been noticed. 
Terror has sometimes induced trains of symptoms closely 
resembling those of the genuine disease. Hysteria also 
occasionally counterfeits it. But these are comparatively 
trivial affections, and wholly undeserving of the name of 
hydrophobia. In the very rare cases which have pursued 
exactly the course and had the termination of that disease, 
it is much more probable that the patient may in some way, 
forgotten or unknown to himself, have received the poison 
into his system, than that the complaint should have arisen 
from any other cause. 

The poison is contained in the saliva or mucus of the 
mouth of the rabid animal, and, as before stated, is generally 
imparted by a bite. It is from the dog that the disease is 
most frequently received. But many others are capable of 
imparting it. The cat, fox, badger, wolf, and jackal are 
known to have communicated the disease. There is good 
reason to believe that the saliva of the horse, ass, ox, etc., 
laboring under hydrophobia, will produce the same effect if 
introduced into the system ; but, ^s these animals do not 
usually bite, the result does not often actually occur. 

Treatment. — The whole magazine of therapeutics has 
been exhausted, and vainly exhausted, in the treatment of 
hydrophobia. Remedies the most violent have been used 
unsparingly ; and practitioners have not been deterred by 
the apparent inertness of any medicament from giving it a 
full trial. Bleeding in every degree, mercury, opium, and all 
other cerebral stimulants, tobacco and all other nervous seda- 
tives, the acids and the alkalies, oil of turpentine, cantharides, 
white hellebore, cevadilla, the salts of lead and those of 
iron, nitrous oxide inhalations, the injection of warm water 
and narcotics into the veins, electricity and galvanism, the 
hot vapor and hot air bath, even the poison of the viper, 
have all been employed, and with the same sad result. 



728 FUNCTIONAL DERANGEMENTS. 

The practitioner is, therefore, left to his own judgment in 
the case. I do not pretend to recommend any course of 
treatment, where I can adduce neither experience nor 
sound therapeutical principles in its support. 

The remedies which promise most are opium and chloro- 
form, and cases have been reported which appeared to have 
been cured by keeping the system steadily under their in- 
fluence for many days. 

But happily an effectual prophylactic treatment seems to 
be in our power. To remove completely the nidus of the 
poison, before the period of incubation is passed, is a meas- 
ure dictated at once by reason and experience. There is 
scarcely a case on record, where this measure has been 
thoroughly carried out at an early period, in which it has 
not proved successful ; every other means of prevention has 
failed upon trial. 

How is the removal of the bitten part to be effected? 
Certainly, best by the knife. The surface should be 
thoroughly washed, and the wound itself, as far as practica- 
ble, so that not a particle of the loose saliva shall remain. 
The whole of the wounded surface should then be excised. 
To give additional security, a stick of lunar caustic should 
afterwards be thoroughly applied to every part of the cut 
surface. After this, nothing more than mild dressings are 
necessary. But there are cases in which this plan cannot 
be carried into effect. The wound mav be so lacerated, or 
may penetrate parts of such a structure, as to render im- 
possible the complete separation of its surface by the knife. 
Here, if the limb is small and of little comparative value, 
amputation may be recommended, as of one of the fingers 
for example ; but when an important member is concerned, 
the patient should be allowed to choose between the incon- 
venience of losing his limb, and the chance of losing his 
life. Should he determine to keep his limb and incur the 
risk, it should be diminished as much as possible by long- 
continued, repeated, and thorough washings of the wound 
by means of a stream of warm water, with the use, in the 
intervals, of a cupping-glass exhausted by means of a 
pump. This should be placed over the wound, in the hope 



NEURALGIA. 729 

that the poison might be eliminated with the blood. Caus- 
tic may then be applied to the surfaces as far as they can 
be reached. 

NEURALGIA. 

Neuralgia is a term employed to designate pain of a 
purely nervous character. 

It may be extended so as to embrace all cases of pain, 
not spasmodic, which cannot be traced directly to vascular 
congestion, inflammation, or other organic lesion. Some 
authors appear to be disposed to limit it to certain parts of 
the body ; but the probability is that it may occur wher- 
ever there are nerves of general sensation ; and even the 
organs chiefly supplied with nerves from the ganglionic sys- 
tem are capable of the affection, either through the connec- 
tion of that system with the common sensorium, or through 
nerves running directly from the organs to the brain. 

Symptoms. — The pain is of every possible degree and 
variety of character; but is generally severe, acute, and 
more or less darting or lancinating. It is sometimes de- 
scribed as piercing, tearing, screwing, pulsating, aching, 
burning, tingling, benumbing, etc. ; and language has been 
ransacked to find terms strong enough, and expressive 
enough, to represent at once its intensity and extreme 
diversity. Sometimes the paroxysm of pain is preceded 
by certain warnings, such as epigastric distress, nausea, 
chilliness or shivering, and a vague feeling of general 
discomfort. More frequently it approaches without any 
such premonition, either beginning moderately with a sense 
of aching, tingling, burning, itching, etc., and gradually in- 
creasing till it becomes almost insupportable, or darting at 
once through the part with its utmost intensity, as it were 
in electric flashes, which make the muscles even of a strong 
man quiver as they pass. The paroxysm may consist of a 
continuous pain, varying in degree, or of a succession of 
violent twinges, with comparative ease in the intervals. In 
the latter case, there _ is often a slight aching, tingling, or 
sense of numbness between the several shootings of pain ; 



730 FUNCTIONAL DERANGEMENTS. 

and the patient sometimes complains of a feeling of cold 
ness scarcely less disagreeable. 

The pain may either be confined to the course of a single 
nerve and its ramifications, or may be diffused without 
reference to such limits, and sometimes darts rapidly from 
one point to another, between which there is no immediate 
nervous communication. 

In some instances, there is tenderness of the part, occa- 
sionally exquisite tenderness ; but more frequently strong 
pressure, instead of being painful, affords some alleviation ; 
and, what appears very singular, in these very cases of in- 
sensibility to forcible impression, a slight touch, the flap- 
ping of a handkerchief, for example, will bring on a violent 
attack ; while I have repeatedly known gentle friction with 
a soft hand to produce complete relief where strong pres- 
sure was intolerable. 

With the pain there is frequently spasmodic twitching 
of the neighboring muscles, and sometimes rigid spasm ; and 
the whole frame is occasionally shaken by the ferocious 
violence of the attack. 

In accordance with the general law, that where there is irri- 
tation there will be an afflux of blood, the paroxysm is often 
attended with more or less flushing and vascular tumes- 
cence, and occasionally, if the affected part has the power 
of secretion, with a copious extravasation of liquid, as, for 
example, of tears when the disease is seated in the eye, 
and of mucus when in the nostrils ; but the exceptions to 
this rule are numerous, and it not unfrequently happens 
that the blood-vessels do not exhibit the least sign of par- 
ticipating in the irritation. 

The course of the affection is scarcely less diversified 
than the character of the pain. In one patient the par- 
oxysm is brief, disappearing after a few minutes, or a few 
hours, not perhaps to return for a considerable time. In 
another it is much more durable, continuing for days or 
weeks ; but in this case there are always remissions, occur- 
ring more or less frequently, and in greater or less degree. 
Generally these remissions are quite irregular, but some- 



NEURALGIA. 731 

times they approach a periodical form, the exacerbation 
occupying a certain portion of the twenty-four hours, while 
during the remainder the patient is comparatively comforta- 
ble. It not unfrequently happens that the neuralgic attacks 
are quite intermittent; and, as in the remittent cases, they 
may be regular or wholly irregular in the recurrence of the 
paroxysms. 

Regular intermittent or periodical neuralgia may be quo- 
tidian or tertian, but is much the most frequently, so far as 
my observation has gone, of the former type. There is no 
particular time of day at which the paroxysms are pecu- 
liarly disposed to recur. They vary much in duration, on 
some occasions occupying the greater portion, on others but 
a small portion of the twenty-four hours. 

The attacks of neuralgic pain occur less frequently in the 
sleeping than the waking state, in part because the patient 
is less exposed to the exciting causes, but chiefly, in all 
probability, because, in the former state, the brain is less 
sensible to impression from the disordered nerve. 

The pain upon disappearing may do so gradually, leaving 
occasionally, as it departs, a sense of tingling or formication 
for a short time behind it; or it may vanish at once and 
completely, so that the patient passes immediately from a 
state of torture to one of entire and most delightful relief. 

In relation to the condition of system associated with 
neuralgia, it may be perfectly healthy, or in various degrees 
debilitated ; it may be plethoric, or anemic ; and the patient 
may be subject to rheumatism or gout, or affected with 
dyspepsia, amenorrhoea, or anomalous nervous disorder of 
the respiratory, circulatory, and reproductive functions ; and 
all these abnormal conditions may have some bearing on the 
complaint. 

The duration of the disease is quite indefinite. The 
patient may have only one attack, which may last more or 
less continuously for minutes, hours, days, weeks, or 
months ; or he may be liable to recurring attacks for a 
number of years, or during his whole life. It is seldom, 
however, that the disease occurs but once. Much more 
frequently the patient continues more or less subject to it 



732 FUNCTIONAL DERANGEMENTS. 

so long as he lives. In the latter case, the recurring 
attacks may be distant, comparatively mild, or in a greater 
or less degree under the control of remedies ; or they may 
increase in duration, violence, and frequency, until at length 
the patient scarcely experiences any exemption, and life 
becomes a protracted torture. Death very seldom occurs 
directly from neuralgia ; but it may by its severity and per- 
sistence so far undermine the health, as to prove indirectly 
fatal by causing the system to sink under diseases which it 
might otherwise surmount. In some instances, death is 
welcomed as an escape from insupportable misery, and it 
has not unfrequently happened that relief has been sought 
in suicide. 

Seats of Neuralgia. — It has been already stated, that the 
disease may attack any part of the body where there are 
nerves. But all parts are not equally susceptible ; and in 
certain positions it is so common, or so peculiar, as to have 
received distinct designations. The neuralgic affections of 
various internal organs have been noticed, in previous parts 
of this work, in connection with other diseases of the same 
parts; as of the heart, under the name of angina pectoris; 
of the stomach, under that of gastralgia ; of the intestines, 
under that of neuralgic colic ; and of the urinary organs, 
under that of nephralgia. It has been noticed also as 
occurring in the encephalon, and in the liver. At present I 
wish merely to call attention to some of its more prominent 
external seats. It sometimes appears to affect the skin ex- 
clusively, but is more frequently seated in the subcutaneous 
nerves ; and though occasionally deep-seated, shows in most 
instances a tendency to the more superficial ramifications. 

Perhaps in no part of the body does the affection occur 
so often as in the head. In the scalp it may be confined to 
one limited spot, or may extend over one-half of its sur- 
face. In the latter case, it is denominated hemicrania. The 
affection which goes by that name is probably sometimes 
cerebral, and appears to be connected with the stomach, as 
one of the forms of sick-headache. But it is often, and 
perhaps most frequently, nothing more than neuralgia of the 
scalp. When of this character, it is exceedingly painful, 



NEURALGIA. 733 

and sometimes of considerable duration. I have known it 
almost incessant for several weeks. In the face, the disease 
in its more violent forms has been called tic douloureux. It 
may affect more especially certain regions of the face, as 
the neighborhood of the eye ; the temporal region ; the 
cheek, lips, etc. ; or it may shoot from one part to the 
other, as if proceeding from some common source. It is 
not unfrequent in and about the eye, producing redness of 
the lids and of the conjunctiva, occasionally swelling of the 
external parts, and a copious flow of tears. Sometimes 
the eyeball is peculiarly affected ; and then there is exces- 
sive susceptibility of the organ, so that the least ray of 
light produces exquisite pain ; and I have known patients 
to complain of intense and painful brightness, though the 
shutters were closed, and the apartment perfectly dark to 
ordinary vision. This painful sensibility of the eye may be 
acute and temporary, or chronic, and in the latter case 
sometimes continues for many years, bidding defiance to all 
kinds of treatment. When the disease attacks the jaws, it 
produces one of the most painful varieties of toothache. 
{See Nervous or Neuralgic Toothache.) The tongue, the 
fauces, and the mucous membrane of the nostrils are liable 
to be severely affected. In the throat, the disease some- 
times imitates angina, and in the nostrils coryza. Otalgia 
or earache is another form of it. This is apt to occur in 
children, and is often exquisitely painful. It may be con- 
fined to the ear, or may radiate to the temples and the 
cheeks ; and is usually accompanied with some perversion 
of hearing, as excessive sensitiveness, partial deafness, or 
unnatural sounds. 

The disease is not common in the neck. In the upper 
extremities, though it may occur in any part, it seizes 
preferably upon the forearm. 

Neuralgia occurs in different parts of the trunk. It is 
not uncommon in the intercostal spaces, and in the lumbar 
region. In the walls of the chest, it is said to occur most 
frequently between the sixth and ninth ribs, on the left side, 
and especially in females, in connection with menstrual dis- 
order. In the female mamma it is sometimes very violent. 



734 FUNCTIONAL DERANGEMENTS. 

When originating in the small of the back, it occasionally 
shoots forward and downward to the groin, and into the 
scrotum and labia pudendi. The anus and the genitals in 
both sexes are sometimes affected with great severity. 

Next to the head, the lower extremities are probably 
most frequently attacked. The disease sometimes pursues 
the course of the crural or femoral nerve, along the inner 
and anterior part of the thigh and leg, down to the top of 
the foot. But much more frequently it occupies the sciatic 
nerve or its branches, constituting a variety of the affection 
so well known under the name of sciatica, and so notorious 
for its obstinacy. This is characterized by irregular pains 
about the hip, spreading thence into neighboring parts, and 
extending downward upon the outside and back of the 
thigh to the leg and foot ; or the pains may begin below 
and shoot upwards ; - or they may occupy distinct and iso- 
lated spots in this long course, sometimes in one part of the 
limb, and sometimes in another, as the knee-joint, the calf 
of the leg, and the sole of the foot. I have known neural- 
gia to be exceedingly violent and obstinate in the knee", imi- 
tating inflammation of the joint, though more painful, and, 
after a long and ineffectual antiphlogistic treatment, including 
confinement to bed, yielding at length completely to the 
subcarbonate of iron and narcotics. 

There can be no doubt that neuralgia is the conse- 
quence of a certain condition of the nervous centre from 
which the nerves supplying the seat of pain originate ; but 
what that condition is we are wholly ignorant of: the best 
we can do is to point out the usual causes which produce 
this condition. These are predisposing or exciting. To the 
former belong such causes as induce a debilitated state of 
system, or any other of those derangements which have 
been enumerated as occasional sources of the affection. 
Among these may be mentioned, as peculiarly operative, all 
kinds of exhausting excesses, and especially those having 
reference to the sexual propensities. The nervous tempera- 
ment is supposed to predispose to neuralgia. It is doubtful 
whether sex has any special influence. There are peculiari- 
ties in the female constitution which predispose it to certain 



NEURALGIA. 735 

forms of neuralgic disease, especially those of a rheumatic 
or gouty nature, or having their seat in the spine ; but these 
are probably balanced by the greater liability of men to the 
complaint from fatigue, exposure, and intemperance of all 
kinds. 

Of the exciting causes, the most frequent is probably 
cold. Exposure to a keen cold air is very apt to bring on 
the neuralgic paroxysm ; and cold and wet conjoined are 
still more effectual. Fatigue, strong mental emotion, ex- 
cesses of the table, intemperate drinking, the abuse of tea, 
coffee, and tobacco, retrocession of gout and rheumatism, 
and the sudden removal of cutaneous eruptions, are exciting 
causes. 

Treatment. — A vast diversity of remedies have been used 
in the treatment of neuralgia, and most of them with some 
apparent success. Being a purely nervous affection, it 
might be expected to be influenced by means calculated to 
make an impression on the mind. The brain, when strongly 
preoccupied, is less sensible to disturbing causes of all kinds ; 
and by directing the current of nervous excitement from 
the seat of disease towards that of intellect and emotion, a 
powerful revulsive influence is exercised. Engage therefore 
the faith, the fears, the wishes, the attention, or any other 
mental function of the patient strongly, and relief will be 
apt to follow. Hence the occasional efficacy of metallic 
tractors, of magnetized rings, of homoeopathic pills, and of 
numberless scarcely less inert applications, in the relief of 
neuralgia. An illustration familiar to every one is the tem- 
porary cure of toothache upon the approach of the dentist. 
Even really efficacious means are frequently very much 
aided by the cooperation of mental influence ; and the physi- 
cian who can most strongly bring this influence to bear upon 
the case will be most likely to obtain at least temporary 
success. I shall not pretend to enumerate all the remedies 
which have been recommended in this complaint ; but shall 
be content with stating the principles upon which it appears 
to me that it should be treated, and the measures that have 
real efficacy, or considerable pretension. 
47 



736 FUNCTIONAL DERANGEMENTS. 

In the first place, we should ascertain if any local irrita- 
tion, or any functional derangement of any of the organs 
which might serve as a source of irritation, when sent 
to the nervous centre, might get up the peculiar condition 
spoken of; and, if so, the remedies calculated to relieve 
this functional derangement, or to remove local irritation, 
should at once be resorted to. 

Neuralgia is often intermittent, and, when not so at first, 
often becomes so. We should always be on the watch for 
this state of the disease ; as, by availing ourselves of the 
power of anti-periodical remedies, we will almost invariably 
be able to arrest it. I do not think I have ever failed in 
curing regular intermittent neuralgia, of the quotidian or 
tertian character, by means of sulphate of quinia, with the 
aid of chloroform liniment applied to the seat of the pain, 
and also to the spine. In general, moderate doses of this 
medicine will answer, say from ten to twenty grains between 
the paroxysms ; but if these should not succeed, the quan- 
tity should be augmented to half a drachm, or a drachm, if 
necessary. Cases which refuse to yield to the smaller 
quantity will sometimes immediately give way to the larger. 
These remedies will often also succeed in the regularly re- 
mittent variety ; and sometimes, after failure at the com- 
mencement, will answer the purpose effectually, if tried at 
a later period. Occasionally a case of neuralgia, commenc- 
ing in an irregularly continuous form, may be brought to the 
remittent or intermittent form by treatment addressed to 
the state of the system. 

The other means calculated to interrupt periodical dis- 
eases will, no doubt, also occasionally succeed, such as an 
emetic, large doses of opium, a blister, etc., employed in 
anticipation of the paroxysm. For a more particular account 
of these, the reader is referred to the subject of intermittent 
fever. 

But we are not without remedies for pure, uncomplicated 
neuralgia, not periodical in its character. So far as my ex- 
perience has gone, the most effectual of these is subcarbon- 
ate of iron, given in connection with the fever syrup. The 



NEURALGIA. 737 

subcarbonate should be administered in large doses, from 
half a drachm to a drachm, or even two drachms, in a table- 
spoonful of the syrup, three times a day. 

In cases originating in a syphilitic or scrofulous taint of 
the system, the following formula has proved very success- 
ful : Fever syrup and comp. syrup of sarsaparilla, each four 
ounces ; iodide of potassa, half an ounce : dose, a dessert- 
spoonful after each meal. 

Oil of turpentine is another alterative remedy which has 
occasionally proved useful, especially in cases connected 
with the sciatic nerve. It should be given in the dose of 
half a teaspoonful, three times a day. 

Local Remedies. — The local treatment of neuralgia is 
important. Much may be done in this way to afford relief 
to the patient. The chloroform liniment I place at the 
head of the list ; but besides this, there are others which 
may be used with much advantage. Laudanum may be 
applied by lotion, or in the form of a cataplasm, care being 
taken to guard against injurious effects from its absorption 
if the cuticle should be broken. The liquid preparations 
of opium and camphor may sometimes be usefully combined. 
The strong tincture of aconite is highly recommended. It 
should be rubbed upon the part till it produces its tingling 
and benumbing effect. Aconitin mixed with lard, in the 
form of ointment, in the proportion of one or two grains to 
a drachm, has been greatly lauded ; but it is expensive, and 
probably in no degree superior to the tincture. Ointments 
mad\e with the extracts of stramonium and belladonna may 
also be applied by friction. A belladonna plaster is some- 
times undoubtedly beneficial. Tobacco cataplasms may be 
used occasionally with great benefit ; but their depressing 
effect, when too freely or too long applied, should be borne 
in mind. 

When the pains affect the anus, uterus, urinary organs, 
or neighboring parts, the anodyne remedy may be most 
efficiently employed in the form of enema. Laudanum, 
under such circumstances, affords usually very speedy 
relief. 

The endermic method of application is sometimes also 



738 FUNCTIONAL DERANGEMENTS. 

highly useful. A small blister may be made in the near 
vicinity of the pain, the cuticle removed, and half a grain 
of powdered sulphate of morphia sprinkled upon the surface. 

Ice or ice-cold water has been recommended as a local 
application, and occasionally affords relief. The same may 
be said of steaming with hot vapor ', or the employment of the 
hot douche. Covering the part with oiled silk, and then 
keeping it warm by a layer of carded wool, probably 
operates usefully in the same mode as the local vapor bath. 
Dry heat, applied by means of burning coals near the part, 
and continued as long as the patient can well bear it, is 
another mode of obtaining ease that should be resorted to. 
I have frequently known relief obtained in a few minutes 
when the pain was in the hips, or the lower end of the back- 
bone, or the anus, by sitting on a heated board. 

Rubefacients, such as oil of turpentine, cayenne pepper, 
and tincture of cantharides ; repeated blistering over tender 
points that may be discovered near the seat of pain ; revul- 
sions by means of setons ; the use of electricity, galvanism, 
and electro-magnetism; are all measures which have strong 
testimony in their favor, and w^hich undoubtedly often pro- 
duce a favorable impression upon the disease. 

Indeed, any thing which for the time modifies the 
nervous condition of the part may occasionally afford 
temporary relief; and I have never known more speedy 
effects from any remedy, than I have sometimes witnessed 
from gentle friction with a soft hand upon the surface. 

In a disease so painful, often so obstinate, and so lasting ; 
and in one, too, so much temporarily under the influence of 
the imagination, it is highly desirable that we should have 
at command an inexhaustible fund of remedies, so that we 
may vary our means to suit the circumstances of the case. 
But there is one rule which we should never forget : that, 
while skirmishing with the lighter auxiliary measures, we 
should not be induced too hastily to relinquish the really 
efficient and curative means which we may have brought to 
bear on the disease. 

After having employed all the resources of the materia 
medica, there yet remain measures which promise most 



^ 



DISEASES OF THE SKIN. 739 

favorably, and which sometimes succeed in apparently 
desperate cases. The nervous system has, in some in- 
stances, been so long accustomed to the neuralgic affection, 
that pain has become its natural mode of action — the condi- 
tion into which it spontaneously falls whenever remedial 
impressions are for a moment removed. It now becomes 
important to change entirely the circumstances under which 
the patient may be placed, to habituate his nervous system 
to new influences, and to sustain the novel impression until 
the system shall have forgotten the old altogether. Such 
an effect occasionally results from a dangerous and pro- 
tracted disease, from which the patient emerges, created as 
it were anew. A safer and more agreeable mode of accom- 
plishing the same end is to send him into a foreign country, 
to be absent at least a year, and. if practicable several 
years ; or upon protracted voyages, the longer the better ; 
or, if neither of these objects be attainable, to change com- 
pletely his mode of life at home. No remedy within my 
observation has been so effectual in obstinate neuralgia as a 
journey to Europe, and a residence abroad for a year or 
more, amidst the exciting novelties, and the various inci- 
dents, pleasing or otherwise, belonging to foreign travel. I 
have no doubt, moreover, that the course of life pursued at 
the hydropathic institutions may sometimes strongly co- 
operate with such influences in revolutionizing the nervous 
system. But such a powerful instrument should not be 
rashly employed, nor without due medical advice. 



DISEASES OF THE SKIN. 

A multitude of skin diseases are described by systematic 
writers ; many of which, however, are so trifling as not to 
require treatment, and others being unknown in this 
country, the reader will not be troubled with their descrip- 
tion : only such as occasion annoyance, either by the suffer- 
ing they cause or their unsightly appearance, will be treated 
of in this work. 

The cutaneous diseases may be arranged in the classes 



740 FUNCTIONAL DERANGEMENTS. 

of — 1. Rashes; 2. Pimples; 3. Vesicles, including bullae, 
4. Pustules; 5. Scales; and, 6. Tubercles. 

Rashes are characterized by a red, superficial efflorescence, 
diffused or in patches, disappearing under pressure, and 
commonly ending in desquamation, [scaling off.] 
' Pimples (papulae) are small, somewhat conical elevations, 
pointed at the top, containing neither lymph nor pus, and 
ending usually in a scurf. 

Vesicles (vesiculae) are circumscribed elevations of the 
cuticle, containing lymph either limpid and colorless, or 
more or less opaque, and whitish or pearl-colored. When large, 
and consisting of a clear fluid separating the cuticle from 
the true skin, they are called bullae, blebs, or small blisters. 

Pustules (pustulae) are circumscribed elevations of the 
cuticle, containing pus. Willan and Bateman make four 
varieties, viz.: 1. Phlyzacium, [blisters,] large, on a hard 
circular base of a vivid red color, and followed by a thick, 
hard, dark scab. 2. Psydracium, [hard elevations,] small, 
often irregularly circumscribed, but slightly elevated, termi- 
nating in a laminated scab, often clustering and confluent, 
and, after the discharge of pus, pouring out a thin watery 
humor, which frequently forms an irregular incrustation. 
3. Achor, [bran,] small, pointed, containing a straw-colored 
matter of the appearance and nearly the consistence of 
strained honey, and succeeded by a thin, brown or yellowish 
scab; and, 4. Favus, [honeycomb,] containing a more 
viscid matter than achor, with a frequently irregular and 
slightly inflamed base, and ending in a yellow, semi-trans- 
parent, and sometimes cellular scab, like a honeycomb. 

Scales (squamae) are hard, thickened, whitish, opaque 
laminae of cuticle. 

Tubercles (tubercula) are small, hard, superficial, circum- 
scribed tumors, permanent or partially suppurating. These 
must not be confounded with the scrofulous or consumptive 
tubercles. 

It is important that the reader should bear in mind that 
the nosological divisions of cutaneous diseases are more or 
less abstractions. They will not by any means always be 
found in nature of the same precise and definite character 
which is given them in the books; and then the treatment 



ERYTHEMA. 741 

of most of them, is so nearly the same that it is not thought 
best to trouble the reader with more than the name of each 
variety and any thing special with regard to its treatment, 
and refer him to the treatment common to all. 

RASHES. 

To this division belong Scarlatina, Rubeola, Erysipelas, 
Roseola, Erythema, and Urticaria. The first three have 
been already treated of, and we will only here speak of 
the three latter varieties. 

ERYTHEMA. 

This eruption is characterized by superficial redness, gen- 
erally in irregular patches, and most commonly confined to 
those parts which rub against each other, as the arm-pits, 
between the nates, and thighs, and in folds of the neck, in 
fat babies, and is well known by nurses by the name of 
chafe. Sometimes it appears to be constitutional, and may 
appear on any part of the body. It often attends other 
diseases, as fevers, bowel complaints, etc. It usually ap- 
pears in patches, by which means it may be distinguished 
from roseola, which it often very much resembles. 

The treatment will consist in removing the cause, and 
sponging the part with a weak solution of sugar of lead, or 
whisky and water. When it is a chafe, it should be 
sponged frequently with alum water to harden the skin. 

SCARLET RASH, OR ROSEOLA. 

This is described as a rose-colored efflorescence, without 
wheals or pimples^ and not contagious. But I have seen 
as much evidence of contagion in this disease as in scarlet 
fever, which it very often accompanies. It is, however, 
very distinct from scarlatina, is not, as some suppose, a 
mild form of that disease, but has a history of its own. 

It requires very little treatment, keeping within doors, 
a light diet for a few days, and dusting the surface with 
wheat flour being sufficient. 



742 FUNCTIONAL DERANGEMENTS. 

NETTLE RASH, OR URTICARIA. 

This is a non-contagious disease, appearing in elevations 
of the skin called wheals. It is attended with a good deal 
of burning or itching, like the sting of the common nettle, 
and is sometimes ushered in by fever and constitutional dis- 
turbance. It is most commonly caused by the presence of 
some other disease, as teething, disordered stomach or 
bowels; but is often the direct effect of fatigue, exposure 
to cold, violent passions, etc., and frequently caused by 
some article of food which disagrees with the stomach. A 
notice of this disease is chiefly important, because of the 
alarm which it often occasions. 

In many acute cases the first symptoms are quite severe, 
and lead to much alarm in the patient or friends. But as 
it is never a dangerous disease, or the cause of any other 
serious disturbance, it is only necessary that the reader 
should be able to discriminate between this and other dis- 
orders of the surface. This is easily done, as no other 
eruption presents a similar appearance; it is enough to say 
that there is no pimple, or vesicle, or tendency to point, 
but a simple elevation, irregular in form, presenting the 
general characteristics of a bite or sting of an insect, but 
differing in that it presents a more irregular form, and will 
apparently subside and then return, in a short time, in full 
force again. 

The treatment in the acute variety is very simple. Bathe 
the surface with tepid water, in wdiich some common soda 
has been dissolved, and then dust it with flour or starch; 
and if there be fever, give the saline mixture; avoid ex- 
posure to cold, or cold applications, as it may cause retro 
cession (striking in) and occasion very serious effects. If 
the disease be thought to arise from worms, or other offend- 
ing matter in the stomach or bowels, it should be treated 
accordingly ; if from teething, the gums should be scarified, 
etc. In the chronic form, it is often rather stubborn, fre- 
quently returning after it has been apparently cured; the 
iodide of potash should be given, and strict scrutiny made to 
ascertain if any article of diet occasions it, desisting from 



LICHEN. 743 

the use of one article after another, until the offending one be 
ascertained. If the disease, either in the acute or chronic 
form, be intermittent, quinine, or some other anti-periodic, 
should be given. 

PAPULiE, OR PIMPLES. 

Many varieties of this disease are given by authors, only 
two of which will be here considered, the others being 
treated of under other heads, or being too insignificant to 
warrant a description. 

LICHEN TETTER. 

The simplest form of this disease is that which occurs in 
very warm weather, known as heat, or prickly heat. It most 
usually appears on those parts of the body which are most 
exposed, as the breast, arms, or legs ; hence mothers often 
make a mistake by leaving their babies nearly naked in 
order to prevent its spread; a light covering of the surface 
is the best protection against it. This form of lichen is so 
common and so easily recognized that I will not occupy 
space with its description, and very little need be said as 
to its cure, though, at times, it becomes very annoying, and 
may lead to serious results by a sudden striking in; it is 
enough, however, to say that the surface should be often 
sponged with tepid water in which either soda or lime has 
been dissolved; and if the complaint proves stubborn, 
sponge it every evening with an infusion of hops in common 
table tea, to which may be added a few drops of oil of sas- 
safras. 

If by imprudent exposure the eruption suddenly disap- 
pears, and causes distress of any kind, the child should be 
bathed in water as hot as it can be borne, and then the seat 
of the eruption covered by a plaster made by mixing one 
part of flour of mustard, with three parts of wheat flour, 
and making it into a paste by adding molasses. Of this 
strength the mustard can be borne, and will gently stimu- 
late the surface, so as to remedy the effect of the retrocession. 

Sometimes lichen assumes a more circumscribed form, 
appearing in patches, or in the form of wheals; hence has 



744 FUNCTIONAL DERANGEMENTS. 

been called lichen urticatus. This variety causes more dis- 
tress, and is more stubborn than the former, and requires 
more active treatment. The saline mixture should be given 
daily, so as to keep the blood cool; but if the system should 
be, or come to be, below par, then tonics should be given, 
as quinine, iron, the vegetable bitters, etc. A lotion made 
by adding equal parts of oil of sassafras, laudanum, and 
glycerine, together, will, I think, always cure it. In this 
composition the sassafras kills the disease, the laudanum 
allays the irritation, and the glycerine protects the surface 
from the action of the atmosphere, but caution must be 
observed lest the laudanum should narcotize the patient. 

PRURIGO, OR ITCHING TETTER. 

In deference to authority I have given this disease a dis- 
tinct heading, but for all practical purposes it may be 
properly considered a mere variety of lichen. In this form, 
however, it remains more persistently in the same place, 
causes less redness of the surface, but more intense 
itching, so that by violent rubbing or scratching the skin 
often becomes abraded, and a sticky exudation is thrown out, 
which on drying causes scurf or scabs. 

This is always a chronic disease, unattended with fever, 
and rarely disturbs the general health, and, like lichen, is not 
contagious. It may be treated as is directed in the former 
disease, except that, being more local and more stubborn, it 
may require more active local applications. If what is 
directed for lichen should fail, then use the following: 

To four ounces of proof spirit add ten grains of corrosive 
sublimate and one drachm (a tea-spoonful) of oil of sassa- 
. fras ; apply night and morning, and every other day wash 
with castile soap-sucfs, and apply the lotion immediately 
after. This preparation will effectually destroy the ani- 
malcule which usually infest the skin in this disease and 
are thought by many to produce it. , 

VESICULAR DISEASES. 

There are many varieties of vesicular diseases, all of 
which are characterized by minute vesicles, which secrete a 



ECZEMA. 745 

pungent acrid humor, which causes a burning, smarting, or 
itching sensation, and are all thought to be contagious. 

HERPES CREEPING ERUPTION. 

This is a vesicular eruption which occurs in circumscribed 
] matches, upon an inflamed base, surrounded by a circle of 
inflamed surface, leaving a space of sound skin between 
them. This disease, if undisturbed, will run its course in a 
few weeks and disappear without the use of any remedies. 
It -should, therefore, be let alone, or only bland, soothing 
applications resorted to, to allay the burning, itching, etc., 
such as gum, or slippery-elm water, with hop tea, etc. 
Some recommend the application of common writing ink, 
and this will prove a good remedy when the disease is sit- 
uated on the face, as it would almost compel the patient to 
remain within doors. 

ECZEMA HOT AND PAINFUL ERUPTION. 

This disease is characterized by patches of numerous 
very minute vesicles, with little or no redness of the skin 
between them. It is attended with very severe smarting 
or itching, which will cause the patient, almost involuntarily, 
to scratch and tear the surface with his nails. It throws 
out a profuse, tenacious secretion, which hardens and forms 
scabs or scales. In many instances when these come off 
the skin is left healthy beneath, and soon returns to its 
natural healthy color. But often successive crusts appear, 
and the case becomes chronic, and sometimes very stub- 
born. When this disease appears on the scalp, the sticky 
secretion will glue and mat the hair together, so as often to 
convert the whole surface into a hard adherent mass, which, 
by being pushed up by a continued deposit beneath, actually 
pulls the hair out by the roots, and may cause permanent 
baldness; but generally the hair is reproduced after the 
disease runs its course, or is removed by appropriate means. 
Sometimes this disease extends from the head to the face, and 
constitutes one of the forms of what is described by authors 
as Crusta Lactea, or it may appear first on the face and. ex- 
tend to various parts of the body in patches, when it is 
generally recognized under this title. 



746 FUNCTIONAL DERANGEMENTS. 

Treatment. — If the case is recent, the treatment is very 
simple. Any febrile symptoms must be removed by small 
doses of the saline mixture, the diet should be light, though 
nourishing, and perfect cleanliness should be preserved. 
The mildest, and, at the same time, the most powerful 
remedy I have ever seen used for tetter of this variety is 
beefs-foot oil, recently made,, and oil of sassafras. The pro- 
portions are two tea-spoonfuls of oil of sassafras to a com- 
mon tea-cupful of the beefs-foot oil. The parts should be 
washed clean with castile soap-suds and wiped dry, and 
then anointed with this mixture. This should be repeated 
daily when the disease is situated on the hands or face, but 
twice a week is often enough when on the scalp or other 
parts kept covered. If the disease has continued until the 
hair is thoroughly matted, and hard scabs formed, great care 
and patience will have to be exercised in getting it cleansed 
the first time. No violent efforts should be made for this 
purpose, but the part, freely anointed with the above prepara- 
tion, should be covered with a poultice every night, and 
washed in the morning with warm soap-suds, until the scabs 
become softened, and can be removed without disturbing 
the surface beneath. 

If the disease should resist this treatment for three or 
four weeks, then try the following : Oil of sassafras, half 
an ounce; corrosive sublimate, thirty grains; proof spirit, 
four ounces ; mix ; apply once a day, until it produces some 
inflammation, then suspend it, and go on with the treatment 
as before. If this should fail to produce some inflammation, 
its strength must be increased by adding .more of the mer- 
curial. I have in a few instances found it necessary to 
make it of the strength of fifteen grains to the ounce, which 
is just double the strength recommended above. No fears 
need be apprehended of injury resulting from the use of 
this powerful poison, combined as directed in the above 
formulae ; as the oil of sassafras effectually destroys its 
capability of harm. I have been obliged to have the above 
mixture compounded under my own eye, druggists being 
afraid to issue a compound of such strength to unknown 
persons. For very delicate children it may be well to com- 



itch. 747 

mence with a preparation containing less of the mercurial, 
say three grains to the ounce, but it must be increased un- 
til it produces the effect desired, that is, some inflammation 
of its own. 

It will often happen that under this treatment the disease 
appears to yield readily; but in a short time new symptoms 
of it will appear, and require the same routine to be gone 
over again, even to the third or fourth time, but each time 
it is more easily subdued than before. The reason, I pre- 
sume, for the necessity of having to cure this complaint 
several times, is, that it is caused by the presence of poison- 
ous animalcule, and that several hunts will be necessary to 
exterminate the last of the race. During the local treat- 
ment, and for some time after, it is best to give the iodide 
of potassa in small doses, namely : put an ounce of potash 
into a quart of water, and give from a tea-spoonful to v a 
table-spoonful after each meal, omitting it every third week. 

SCABIES ITCHING TETTER ITCH. 

Most persons are sufficiently acquainted with this vexa- 
tious disease to recognize it without any formal description. 
It loves a situation where the skin is thinnest and least ex- 
posed to rubbing, as between the fingers, in the armpit, be- 
tween the thighs, etc. A form of this disease, introduced 
into this country during the war, and known as the army 
itch, is not so particular as to its settlement, but locates on 
any part of the body. This form of itch is, I think, a 
variety of herpes. Very little more is now known as to 
the treatment of this troublesome complaint than was known 
by our ancestors; the most effectual remedy is that which 
has been relied on from a period beyond which the memory 
of man runneth not, that is, sulphur used externally, or in- 
ternally, or in both ways at once. "A thousand and one" 
remedies have been recommended, but this is a sure thing, 
and subject to as few objections as any other when used 
properly. I use it internally exclusively, it being not so 
annoying by its offensive odor, and never causing unpleas- 
ant effects by exposure to wet and cold, as is the case when 
used externally. 



748 FUNCTIONAL DERANGEMENT. 

My plan of procedure is as follows : add two ounces of 
flour of sulphur to four ounces of honey, or molasses, and 
dissolve half an ounce of the iodide of potash in four ounces 
of water; and after having rubbed the sulphur and honey 
together, add the solution of potash, and mix them thor- 
oughly; of this give from a tea-spoonful to a table-spoonful 
after each meal; given after eating ', it mixes with the food, 
and is absorbed with it, and thus finds an entrance into 
the circulation, and reaches the surface in such a way that 
no point can escape its contact. 

Immediate relief can be obtained and the cure expedited 
by also using an external application at the same time. The 
lotion recommended in lichen, namely, equal parts of oil of 
sassafras, laudanum, and glycerine, will give full satisfaction. 
But care must be taken not to poison babies by the absorp- 
tion of the laudanum. 

MILLIARY ERUPTION SUDAMINA. 

The above name is given to an eruption which often 
appears in low conditions of the system, as in the last 
stage of fevers and other acute diseases. It consists in 
very minute vesicles containing a perfectly transparent 
liquid, without redness or soreness, and disappears without 
the use of any remedies. It seems to be simply an exuda- 
tion of transparent, colorless lymph under the cuticle, and 
is called sweat eruption. 

PEMPHIGUS VESICLE . 

This eruption assumes the form of bullae, or blebs, or 
small blisters. It is much of the nature of that last de- 
scribed, differing only in the size of the vesicle, which is 
often as large as a cherry cut in two, and much resembles 
one, except in color, which is usually milky when not 
entirely transparent. It requires no especial treatment 
except flour or starch to absorb the discharge if the blis- 
ters should happen to become broken. As it always ap- 
pears as a mere attendant on some other disease, or in a 
weak and depraved condition of the system produced by 



RUPIA. 749 

other causes, resort must be had to remedies addressed to 
the existing state of the general system. 

RUPIA. 

This appears to be an eruption partaking of the char- 
acter of pemphigus and ecthyma. The eruption is rather 
smaller than pemphigus, is more distinct than ecthyma. It, 
however, is like it in usually being filled with a clear, 
transparent fluid, but occasionally contains pus, has an in- 
flamed margin which concretes into a hard scab or exudes 
a serous acrid matter, thus partaking of the nature of pem- 
phigus. As the treatment of this disease is the same as 
that directed for the two complaints named, according as it 
presents the character of one or the other, the reader is re- 
ferred to them. 

PUSTULAR DISEASES. 

Pustules differ from vesicles in that they contain pus, 
which is usually of an acrid quality, and occasions much 
uneasiness by the smarting, burning, or itching which 
attends it. 

ECTHYMA — (TO RAGE.) 

This disease is described as consisting of blistering pus- 
tules, distinct, without fever, and not contagious. It com- 
monly first makes its appearance as conical elevations the 
size of a split pea or less, very red and painful. The pus- 
tules occur most frequently on the neck and shoulders, 
sometimes on the extremities, but never on the face or 
head. In a few days they exhibit a little pus at the sum- 
mit, and present the appearance of small boils, which in a 
short time break, and discharge a thick acrid matter that 
soon concretes into hard scabs; these separate and come 
off in two or three weeks, leaving a dark-red surface, and 
sometimes a slight scar in the center. This constitutes the 
acute form, and the irritation occasioned by so many little 
angry boils is often sufficient to produce considerable symp- 
tomatic fever. The application of tartar emetic, the skin 
of old bacon, and some other things will produce a crop of 
this eruption, which can not be distinguished from that aris- 



750 FUNCTIONAL DERANGEMENTS. 

ing from constitutional causes, and will enable the reader to 
understand what is meant by the term ecthyma, and make 
it easy to diagnose it. It often happens that as one crop of 
this eruption dries up another makes its appearance, and 
we occasionally see them in every stage of development on 
the body at the same time, and in this way the disease be- 
comes chronic; but no difference how often the crops are 
repeated, each retains its acute character. In the old, the 
intemperate, and in low states of the system generally, the 
eruption presents a dark or purplish hue. 

The treatment consists in soothing applications to the 
surface, gentle purgatives, as the saline mixture, when the 
action is too high, and stimulants and tonics when it is too 
low, and anodynes or opiates to relieve excessive restless- 
ness and procure sleep. If the disease proves stubborn 
resort may be had to more active means; as, laudanum, one 
table-spoonful; spirits of camphor and glycerine, each three 
table-spoonfuls; water, half a pint. Sponge the surface 
with this three times a day. If this should fail, then take, 
oil of sassafras, half an ounce; tinct. of iodine and tinct. of 
arnica, each one ounce; glycerine, one and a half ounces. 
Mix, and apply with a little mop or sponge to the pustules 
three times a day. All these remedies may be used at the 
same time. Quinine has a good effect. 

IMPETIGO (TO INFEST) MOIST TETTER. 

This disease consists in very minute pustules, which 
appear in clusters, and when the discharge from them dries, 
forms disagreeable-looking scabs, especially on the face; 
when in the hair it forms one of the varieties of scald- 
head. The treatment of impetigo is precisely the same as 
that directed for ecthyma, and need not be repeated. 

PORRIGO (POROUS) TINEA CAPITIS SCALD-HEAD. 

The characteristic feature of this , disease is that it con- 
sists of small favoas pustules — namely, pitted, reticulated — 
like the cells of a honey-comb. These may be scattered, or 
they may appear in clusters and coalesce, or run together, 
so as to form large sores, sometimes involving the whole 



ACNE. 751 

scalp. Each of these little ulcers throws out a yellowish, 
tenacious secretion, which soon hardens, often glueing the 
hairs together, until the whole surface becomes incased in 
a thick, hard substance, as unyielding as a gourd. This 
cover continues to increase in thickness by fresh additions 
from beneath ; and, if not interfered with, may continue for 
years, and, affording a convenient shelter for vermin, often 
presents a most disgusting appearance. Ulceration may go 
on under these scabs until deep excavations are made in 
the scalp, even, it is said, penetrating to the bone, and 
causing the outer table to become carious. 

In many of its characteristics porrigo resembles eczema, 
but they differ in that the latter throws off a serous, 
watery secretion, and the former an acrid pus; then eczema 
never destroys the integrity of the true skin, while porrigo 
often makes deep excavations; but they might be consid- 
ered the same disease so far as the treatment is concerned, 
and the reader is therefore referred to what is said under 
the head of eczema for the management of scald-head. 

ACNE (VIGOR OF LIFE) HARD PIMPLE. 

This disease is a great source of annoyance to the 
patient; occurring, as it does, about the season of puberty, 
when good looks is the subject of much solicitude; it is in- 
deed vexatious to have the face disfigured by the presence 
of tbese courage bumps. But the cure is usually easily 
effected. Abstain from stimulating food and drinks, keep 
the blood cool by a daily use of the saline mixture, and 
daily bathe the parts in a weak solution of common soda. 
If it should resist this treatment, add one grain of corro- 
sive sublimate to the pint of soda water, and every day 
increase it one grain until the pimples disappear, or some 
inflammation is set up; then discontinue the mercurial and 
apply glycerine. Should the pimples return, use the mix- 
ture of the strength last used. Perseverance in this plan 
will certainly remove the disease. 

ROSACEA ROSE-LIKE. 

This is also a disease whose importance chiefly consists 
48 



752 FUNCTIONAL DERANGEMENTS. 

in its marring the "human face divine." It generally com 
mences on the nose, and often continues to be limited to 
this locality. It chiefly attacks the old and the intemper- 
ate, and, from its shining red or purple color, is known as 
tvhisJey or rum blossom. It also should be treated as eczema. 
But no remedies will succeed without a change of habits; 
the intemperate must quit his cups, the sedentary must eat 
less and exercise more, and the old must limit his diet to 
the real wants of the system, using that which . is nutri- 
tious but unstimulating. 

SCALY DISEASES. 

A number of scaly diseases are described by authors, 
but we will only note the following: 

PSORIASIS DRY TETTER. 

This disease will be readily recognized by the reader, it 
being the most common form in which that class of dis- 
eases known as tetter is usually met with. It consists of a 
hardness and roughness of the skin, attended with most 
violent spells of itching, especially when the patient gets 
warm, after exposure to cold, or on going to bed. It mostly 
attacks the outside of the legs or arms, but occasionally is 
found on the abdomen or back. The internal treatment 
should be the same as that directed in scrofula, this being 
one form in which that disease manifests itself. The local 
treatment should be the beefs-foot oil and oil of sassafras, 
with the addition of corrosive sublimate if necessary. This 
disease often attacks the hands, rendering the skin hard and 
unyielding, often exhibiting unsightly and painful cracks or 
fissures in the skin, and causing the finger-nails to assume 
grotesque appearances. In order to effect a cure in these 
cases it is essential that the hands should be enveloped in 
leather gloves. When the duties devolving upon the indi- 
vidual render this impossible, a cure can be effected by 
keeping the gloves on at night only. 

RINGWORM — PORRIGO SCUTULATA. 

This is another skin disease which is worthy of mention 



DANDRUFF. 753 

only because of its unsightly appearance, especially when 
it locates on the cheek, which it often does. It usually 
makes its appearance about puberty, and is indicative of 
constitutional vigor. We meet among the masses with 
many infallible cures for ringworm, many of which have 
doubtless obtained their celebrity from having been used at 
the precise time when the disease would have disappeared 
of itself — for it does not live forever, but has a determinate 
period of existence, which, however, is rather long for the 
patience of those whose good looks it so materially mars. 
A very common prescription for this disease among the 
people is to rub it with the juice of a green walnut; but 
this produces a very unsightly stain, and often fails to cure. 
An application of nitrate of silver, ten grains to a tea-spoon- 
ful of rain-water, will cure it at once, but this also disfig- 
ures the countenance for a time. The same thing can be 
accomplished, without any considerable discoloration of the 
skin, by the following recipe : 

R Bi chloride of mercury, (corrosive sublimate,) . . 10 grains. 

Oil of sassafras, 1 drachm. 

Alcohol, 1 ounce. 

Mix. 

Moisten the ringworm with this every night, and in the 
morning after washing. Perhaps the first application will 
excite some inflammation; wait until this subsides, keeping 
the part moistened with glycerine. After a few days, if 
the disease should not appear to be thoroughly killed, make 
another application of the medicine ; two or three trials will 
insure success. 

PITYRIASIS DANDRUFF. 

There are many varieties of this disease, but all are so 
nearly alike as not to require a separate description. The 
distinctive features consist in a rapid formation of bran- 
like scales, attended with considerable itching. It mostly 
appears in the head, or other parts covered with hair. It 
often is seated in the eyelids, and causes the eyelashes to 
fall out. Any of the strong lotions recommended for 
destroying the specific action in other skin diseases are of 



754 FUNCTIONAL DERANGEMENTS. 

service in this, as the dilute mineral acids, the solution of 
corrosive sublimate, etc. ; but the mildest remedy which I 
have found to prove effectual is a drachm of common soda 
and thirty drops of oil of sassafras, dissolved in four ounces 
of alcohol. This should be well applied once or twice 
every day with a soft brush, and continued for some time 
after the disease has apparently disappeared. 

CORNS. 

Corns are nothing more than thickened and condensed 
epithelium, or scarf-skin, which, by a succession of layers, 
often acquire considerable thickness, rising above the sur- 
face and imbedded into the tissues, and by their pressure 
upon the nerves often occasion much suffering. 

Corns are always the result of unequal pressure, made 
by a badly-fitting shoe or boot. A tight shoe, if made to 
conform to the contour of the foot, may occasion other 
kinds of mischief, by impeding the circulation, causing head- 
ache, etc., but it will not produce corns. The Chinese 
compress the feet of female children so as to prevent their 
growth, but yet this cruel and foolish practice does not 
occasion corns. This is a point of some importance, for the 
idea that it is a tight fit that occasions the growth of corns, 
often induces parents to force their growing daughters to 
wear shoes too large for them, and of course only touching 
the foot in places. Now, if the material be unyielding, the 
point of pressure will as certainly become the seat of a 
hypertrophy, or thickening of the epithelium, as effect 
follows its cause. The true secret, therefore, of preventing 
corns is to wear good-fitting shoes or boots, and at least 
once a week bathe the feet in bran* and warm water, so as 
to soften and remove the cast-off scarf-skin. And this also 
constitutes the best means of cure after they are formed ; 
but in this case the bathing must take place every night, 
and at each time as much of the hardened cuticle should be 
removed as N can be easily done, and then covered with a fine 
cloth which has been rubbed with a piece of mild soap 
until sufficient has adhered to cover the cloth. This simple 
process will inevitably cure the corn if persevered in \ but 



WARTS. 755 

it will return again after removal in this or any other way, 
except unequal pressure should be avoided. Persons sub- 
ject to corns should employ some sensible shoemaker to 
manufacture their shoes or boots, who understands the true 
shape of the foot, and can make a neat fit without pro- 
ducing unequal pressure. The material should always be 
the best calf, and it should be kept pliant by an occasional 
oiling. 

WARTS. 

Warts are the only variety of tubercular skin disease 
which will be noticed, as the others mentioned by authors, 
as yaws, elephantiasis, etc., are unknown in this country. 
A description of warts is quite unnecessary, as every one 
is familiar with their appearance. They usually appear in 
clusters, and there is always one or more which is larger 
and of a rougher texture than the rest, and is called the 
mother-wart or seed-wart. As warts very often sponta- 
neously disappear, various inert substances arid foolish 
devices have gained credence among the people as cures. 
Nothing more is commonly necessary to cause a whole 
family of warts to disappear than to cut the top of the 
mother-wart until it bleeds a little, and then dip a quill 
into nitric acid, and hold it for a minute or two with the 
end touching the cut surface ; a soft poultice should now be 
applied. For some days the wart operated on will be a 
little sore, and thus draw your attention to the subject; but 
when this ceases to annoy, you will probably forget the 
warts, and when you again think of them, you will find 
they have all disappeared. 



756 MISCELLANEOUS DISEASES. 



MISCELLANEOUS DISEASES. 



The following diseases, being of a mixed or specific cha- 
racter, could not well come under any of the preceding 
heads, and are therefore grouped together under the above 
title. 

APOPLEXY. 

By the term apoplexy is meant sudden insensibility, the 
loss of sensation, thought, and voluntary motion, with a 
more or less severe disturbance of the functions of respira- 
tion and circulation. It is a state of coma occurring spon- 
taneously and suddenly. 

It is often a matter of difficulty to distinguish between 
apoplectic coma and that due to a narcotic poison, or to 
drunkenness. The distinction is most important as regards 
the treatment. The coma is profound in each instance, 
though arising from so different a cause ; the history of the 
case, the general appearance and age, and the presence or 
absence of the odor of spirits in the breath, are the only 
points which help to solve the difficulty. 

The state of coma may end in three ways. Either it may 
gradually pass off, leaving the patient well, or it may termi- 
nate in incomplete recovery, the mind being impaired, and 
some parts of the body paralyzed ; or it may cease in death. 
On examining the brain, we find either no appearance what- 
ever of disease, or extravasated blood, or effusion of serum 
into the ventricles or beneath the arachnoid. Dr. Aber- 
crombie calls the first, that which is fatal without leaving 
any traces, simple apoplexy; the second, sanguineous apo- 



APOPLEXY. 757 

plexy, or cerebral hemorrhage ; the third, serous apoplexy. 
During life, we are unable to distinguish by the symptoms 
these three varieties. 

Warnings. — This dreadful visitation is seldom experienced 
without some previous threatenings, which, properly inter- 
preted, should put the patient on his guard. The following 
individuals may be said to be predisposed to apoplexy : those 
whose ancestors suffered from it ; men of a peculiar habit 
of body, with a large head, florid face, and short, thick neck ; 
and individuals advanced in life, beyond fifty. A predispo- 
sition may also be engendered by disease of the kidneys, 
of the heart, or of the cerebral blood-vessels, by intempe- 
rance, and by the cessation of habitual discharges. Among 
the threatenings, the following are the most important : 
headache ; giddiness, particularly on stooping ; a feeling of 
weight and fulness in the head ; noises in the ears ; tran- 
sient deafness or transient blindness ; double vision ; occa- 
sionally epistaxis ; numbness; loss of memory; great men- 
tal depression ; incoherent talking ; drowsiness ; indis- 
tinctness of articulation, and partial paralysis, sometimes 
affecting a limb, sometimes the muscles of the face, sometimes 
the eyelids. 

Modes of Seizure. — Dr. Abercrombie has shown that the 
apoplectic attack commences in three different ways. " In 
the first form of the attack, the patient falls down suddenly, 
deprived of sense and motion, and lies like a person in a 
deep sleep, his face generally flushed, his breathing ster- 
torous, his pulse full and not frequent, sometimes below the 
natural standard. In some of these cases, convulsions occur; 
in others, rigidity and contraction of the muscles of the 
limbs, sometimes on one side only." 

In the second form, the coma is not the first symptom, 
but rather a sudden attack of pain in the head ; the patient 
becomes pale, sick and faint, sometimes vomits, and fre- 
quently falls down in a state resembling syncope. Occa- 
sionally he does not fall down, the sudden attack of pain 
being merely accompanied by slight and transient loss of 
memory. After a few hours, however, the headache con- 
tinuing, he becomes heavy, oppressed, forgetful, and graclu- 



758 MISCELLANEOUS DISEASES. 

ally sinks into perfect coma, from which recovery is rare. 
A large clot is usually found in the brain. 

The third form of apoplectic seizure begins with a sudden 
attack of paralysis of one side of the body, with loss of 
speech, but no loss of consciousness. The paralysis passes 
gradually into apoplexy; or, in some favorable cases, it 
slowly goes off, and the patient recovers. 

Phenomena during the Fit. — The duration of the apoplec- 
tic fit varies from two or three hours to as many days. 
There is total unconsciousness ; pulse, at first generally 
small, becomes full and strong according as the system re- 
covers from the shock ; it is usually slower than natural, 
sometimes intermitting ; respiration slow, embarrassed, often 
accompanied by stertor ; frothy saliva about the mouth. 
In bad cases, the body is covered with a cold, clammy 
sweat ; the face is pale ; the eyes dull and glassy, with dila- 
tation of the pupils ; the teeth firmly clenched ; power of 
deglutition lost, or much impeded ; torpidity of the bowels, 
or, if they act, the motions are passed involuntarily ; and 
either involuntary micturition, or, as most frequently hap- 
pens, retention of urine until the bladder becomes distended, 
overflows, as it were, and causes the urine to be constantly 
dribbling away. When the patient recovers incompletely, 
paralysis remains. 

Treatment. — This may be divided into that which is pro- 
phylactic, and that which is required when an attack has 
occurred. 

Prophylaxis. — When a predisposition to apoplexy is sus- 
pected, the individual should avoid strong bodily exertion ; 
venereal excitement ; the stimulus and irritation of drunk- 
enness ; violent mental emotion; straining at stool; long- 
continued stooping ; tight neckcloths ; too much indulgence 
in sleep ; and warm baths. He should observe a cool spare 
diet, free from alcoholic drinks ; regular exercise ; and must 
pay great attention to his bowels. Washing the head daily 
with cold water, or establishing a drain near the head by 
means of an issue or seton in the neck, will perhaps do good. 
When giddiness, headache, throbbing of the arteries of the 
head, and epistaxis are present, much benefit will result 



APOPLEXY. 759 

from active purging, and from blistering the nape of the 
neck'. 

When an attack has occurred. — Formerly the treatment of 
every attack of apoplexy was commenced by bleeding ; and 
statistics prove that the more the blood was taken away, the 
greater was the mortality. This can easily be imagined, for 
we only see the patient when the mischief is done : rupture 
and extravasation of blood has taken place, and bleeding 
won't remove it. But it is said depletion will prevent fur- 
ther extravasation. It is more probable that, so far from its 
doing so, it promotes it, by inducing greater thinness of the 
blood, and by diminishing its power of coagulating. In 
proof of this, it is only necessary to read the reports of not 
a few cases, where it is distinctly stated that the abstraction 
of blood was immediately followed by an aggravation of the 
symptoms and by paralysis. The rule to adopt is that laid 
down by Cullen — to obviate the tendency to death. If the 
tendency be towards death by coma; if the pulse be full, 
or hard, or thrilling ; if the vessels of the neck are congest- 
ed, and if the face be flushed and turgid, then bloodletting 
may be called for. If, on the contrary, the patient is dying 
from syncope, with a feeble or almost imperceptible pulse, 
and a cold, clammy skin, then bleeding will only insure a 
speedily fatal termination. In either case, the patient should 
be removed into a cool, well-ventilated room; his head should 
be raised ; all the tight parts of his dress loosened, espe- 
cially his cravat and shirt-collar ; and cold applied to the 
head by means of pounded ice in a bladder. If bleeding be 
decided on, it is best to do it by means of leeches applied 
to the nostrils or to the nape of the neck. 

Active purgatives do good in most cases. If the patient 
can swallow, a full dose of calomel and jalap, followed by 
the common black draught, may be given. If the power of 
deglutition be lost, three or four drops of croton oil should 
be put on the back part of the tongue. Stimulating ene- 
mata should also be thrown up the rectum. Blisters are 
often subsequently of use, applied over the scalp or to the 
neck. Some recommend emetics : unless the attack was 
clearly due to an overloaded stomach, I should avoid them. 



760 MISCELLANEOUS DISEASES. 

CONCUSSION OF THE BRAIN. 

Concussion of the brain is signalized by fainting, sickness, 
stupor, insensibility, or sudden death, succeeding immediately 
to some blow or some act of external violence. Although 
cases of this kind are usually regarded as surgical, yet their 
importance demands so imperatively that every one should 
be well acquainted with their symptoms, treatment, etc., that 
no apology is needed for the introduction of this section. 

Symptoms. — These will vary according to the degree of 
concussion. When the shock has only been slight, the per- 
son soon recovers from the state of unconsciousness, and 
complains only of confusion of ideas, faintness, sickness, a 
desire to sleep, and ringing noises in his ears. In a more 
severe case, the insensibility continues longer ; the patient 
lies as if in a deep slumber, his pupils are insensible to the 
stimulus of light, and his' breathing is often scarcely per- 
ceptible. * When, after a variable interval, partial recovery 
ensues, there is great confusion of .thought, often an inability 
to articulate distinctly, frequently severe vomiting, and 
sometimes paralysis of one or other of the extremities. 
In the worst forms of concussion, the person is felled to the 
ground by the shock, whatever it may be, and dies upon the 
spot. 

Diagnosis. — The following circumstances, according to 
Chelius, distinguish concussion from pressure upon the brain 
caused by extravasation of blood. In concussion which 
immediately follows external violence, the patient usually 
recovers himself in some degree. In extravasation, he lies 
in an apoplectic state, with snoring, difficult breathing, hard, 
irregular, intermitting pulse, with pupils widely dilated, but 
no vomiting. In concussion, the body is cold ; the breathing 
easy ; the pulse regular and small ; the countenance little 
changed. Extravasation and concussion may, it must be 
remembered, occur together. It is often difficult to distin- 
guish between concussion and drunkenness. The history 
of the patient, his general appearance, and the smell of his 
breath, are the chief points to attend to. 

Prognosis. — This must in all cases be guarded. In a 



TOOTHACHE. 761 

severe form of concussion, the convalescence is always 
tedious ; and it frequently leaves behind it permanent im- 
pairment of the memory, loss of smell or taste, and weak- 
ness of sight or even amaurosis. 

Treatment. — In all cases the patient should be carefully 
watched. If, a few hours after recovery from the shock, 
the reaction seem to be intense, the head should be elevated, 
and cold applied; two or 'three drops of croton oil may also 
be placed on the tongue. Generally speaking, however, the 
shock to the system is so great that mild stimulants are 
necessary ; and a little wine, or brandy and water, should 
be cautiously administered. At the same time, if the sur- 
face be cold, warmth must be applied by means of blankets, 
bottles of hot water, hot bricks, etc. In the after-treatment 
of these cases, a mild unstimulating diet, rest and quiet, 
with gentle purgatives, will alone be necessary. 

TOOTHACHE, OR ODONTALGIA. 

Toothache offers every possible variety in degree, charac- 
ter, and duration. The pain runs through all the grades 
which intervene between a slight sensation of uneasiness 
and insupportable agony. It may be dull, aching, heavy, 
sharp, pungent, throbbing, grinding, or lancinating. It may 
be continued or paroxysmal, remittent or intermittent, and 
regular or irregular in its recurrence. It may come in 
flashes, and as suddenly disappear ; or may continue a long 
time with little variation. Its varieties will be best con- 
sidered under the different pathological conditions which it 
attends. 

NERVOUS OR NEURALGIC TOOTHACHE. 

A purely neuralgic condition of the teeth is not uncom- 
mon. The affection may be seated in the nerve of a single 
tooth ; but it much more commonly occupies the nervous 
trunk from which several teeth are supplied ; and not un- 
frequently affects rather the jaw than the teeth themselves. 

The pain is usually of the acute character, sometimes 
mild in the beginning, gradually increasing in intensity, and 



762 MISCELLANEOUS DISEASES. 

as gradually declining ; but usually very irregular, at one 
time moderate, at another severe, and occasionally darting 
with excruciating violence through the dental arches. Not 
unfrequently it assumes a regularly intermittent form. 

This variety of toothache may depend on a morbid state 
of the nerve or nerves which are the immediate seat of it, 
but more frequently originates in a condition of the nervous 
system, such as disposes to neuralgic pains generally. 
With an existing predisposition, it is sometimes invited by 
caries, but very frequently occurs in teeth which are per- 
fectly sound. Almost any thing which disturbs the system 
may serve as an exciting cause; but the most frequent 
causes are probably vicissitudes of weather, and the appli- 
cation of very cold or very hot substances to the teeth, 
especially in alternation. The disease appears to be some- 
times sympathetic with morbid states of the stomach or 
other distant organs ; and not unfrequently occurs in per- 
sons of a gouty or rheumatic diathesis. 

Treatment. — When the neuralgic affection can be traced 
to sympathy with disease elsewhere, this should be cor- 
rected. Thus, antacids should be given in acidity of 
stomach, laxatives in constipation of the bowels, the blue- 
mass or calomel in deranged or deficient hepatic secretion, 
aloes or other emmenagogue in amenorrhoea ; and not un- 
frequently the coexistence of two or more of these affec 
tions calls for the simultaneous use of the appropriate 
remedies. If a rheumatic or gouty diathesis be suspected, 
wine of colchicum, hot pediluvia, and other means adapted 
to these disorders, may be tried. Peruvian bark or sulphate 
of quinia will be found an almost certain remedy in regular 
intermittent cases, and often useful in others. 

All the remedies, both local and general, recommended 
under the head of neuralgia, may be brought to bear upon 
this particular variety. Immediate ease can nearly always 
be obtained by bathing the side of the face with chloroform 
liniment ; a little lint or cotton may also be saturated with 
it, and applied immediately to the tooth. Carious teeth 
should generally be removed. 



TOOTHACHE. 763 



INFLAMMATOKY TOOTHACHE. 

This may exist with or without caries ; but is in the 
great majority of instances dependent uppn that affection. 
Before proceeding, therefore, to an account of its phenomena, 
it will be proper to say a few words on the subject of cari- 
ous teeth. 

Caries is an affection of the interior or bony structure of 
the teeth, the enamel being without vitality, and not there- 
fore subject to morbid action. 

Caries sometimes begins on the internal surface of the 
tooth, and extends outward, exhibiting usually, as the first 
evidence of its existence, a dark appearance beneath the 
enamel. But much more frequently it proceeds from with- 
out inward, commencing in the bone immediately beneath 
the enamel, and exhibiting a yellowish or brownish spot in 
this situation. In some cases, especially when the surface 
is black or very dark, the caries advances very slowly, or 
is altogether arrested. In such cases, the surface is com- 
monly also harder and less friable than in the yellowish 
caries. 

This decay of the teeth is not necessarily attended with 
pain. Occasionally the affection runs through its whole 
course with little or no suffering to the individual; and 
sometimes, after having been painful, it ceases at certain 
periods of life to be so, though the process of decay may 
continue. In some instances of caries without toothache, 
the irritation appears to be felt sympathetically in other 
parts; and painful affections of the head, ears, and eyes, 
have ceased upon the extraction of a decayed tooth which 
had never ached. 

The most frequent cause of caries is probably some con- 
dition of the bone acquired during its formation, in conse- 
quence of peculiarity of constitution, or the state of health 
existing at the time. Thus, persons affected with scrofula 
or scurvy, during dentition, are apt to be affected with 
decay of the teeth in after life. There is reason also to 
believe that the predisposition is sometimes hereditary. 
Women and young children are more subject to the disease 



764 MISCELLANEOUS DISEASES. 

than men. The direct or exciting causes are either such 
as destroy the integrity of the enamel, and thereby expose 
the bone to the influence of irritant substances, or such as 
operate directly upon its vital susceptibilities. Among the 
former are acids and other corrosive substances taken into 
the mouth, sour eructations from the stomach, depraved 
salivary or mucous secretions, the sordes which collect 
about uncleaned teeth, the contact or near vicinity of a 
carious surface in another tooth, the attrition of opposing 
surfaces of the teeth, and all kinds of mechanical violence. 
Of the latter, the principal are heat and cold suddenly ap- 
plied, and especially in quick alternation. Hence it is, 
perhaps, in part, that caries of the teeth is more common in 
civilized life, where hot drinks are habitually used, than 
among savages. The very free use of sugar, as an article 
of diet, is thought by many to be a frequent cause of the 
disease. Some have ascribed its effects to a direct action 
on the teeth ; but it is more probable that it operates, if at 
all, by impairing digestion. Whatever deranges the diges- 
tive function may occasion caries indirectly, by giving rise 
to acrid and corrosive eructations, and by altering the secre- 
tions which are poured into the mouth. Nevertheless, 
sugar is certainly strongly irritant to the dental nerves ; as 
is evinced by the severe toothache so often occasioned by 
its contact with a carious surface. 

When the caries is slight, and especially when it occupies 
the sides of the teeth, it may often be arrested by remov- 
ing the diseased portion with the file ; and the same end 
may be attained by filling the cavity with some metallic 
substance, such as lead, tin-foil, or gold leaf, so as to ex- 
clude the air and all irritant bodies. Plugging may be 
resorted to in all cases when the tooth has not begun to ache, 
or when it has ached but moderately and for a short time. 

The inflammation which occasions toothache may be 
seated in the pulp of the tooth, in the cord which enters 
its lower extremity, or in the periosteum investing its roots, 
and reflected over the interior of the alveolar cavity. At 
first the pain is usually moderate, and it may continue thus 
throughout ; but generally it increases, and at length be- 



TOOTHACHE. 765 

comes intense, in consequence probably of the pressure to 
which the swollen and inflamed parts are subjected by the 
unyielding bone around them. The tooth is at the same 
time very tender ; and any force applied to it greatly in- 
creases the pain. The inflammation is propagated by con- 
tiguous sympathy to the gum and other parts of the face, 
which become much swollen ; and the swelling sometimes 
extends to the salivary and absorbent glands, and even to 
the tonsils. The violence of the pain often abates some- 
what, upon the occurrence of this external inflammation, 
which appears to act as a revulsive. The tumefaction not 
unfrequently subsides, without the occurrence of suppura- 
tion, and the toothache ceases for a time. Very frequently, 
however, an abscess forms either in the gum, upon the 
upper or lower jaws, in the roof of the mouth, or, more 
rarely, in the substance of the cheek. There is often much 
constitutional disturbance, with fever, headache, and ina- 
bility to sleep. The pain, during the suppurative stage, is 
usually pulsative or throbbing. The abscess at length 
opens, and relief is obtained. 

Suppuration also takes place in the pulp or dental cord. 
If an opening exist into the central cavity of the tooth, the 
pus may be discharged by this route ; but if there be no 
such outlet, the matter accumulating occasions inflamma- 
tion and absorption of the socket, and thus makes itself a 
way out, either between the tooth and the gum, or directly 
through the latter, forming an abscess in its substance. 
When this opens, the pain is relieved ; but the opening is 
apt to become fistulous, and a continual purulent discharge 
to be maintained until the tooth is wholly removed. 

The most frequent cause of these, inflammatory affections 
is the exposure of the pulp, consequent caries, Or other 
destruction of the tooth. 

Treatment. — Little general treatment is requisite. Saline 
cathartics, and abstinence from animal food, may be recom- 
mended when the inflammation affects the neighboring parts ; 
and an opiate at night is generally advisable when the pain 
is severe. The loss of blood may become necessary if there 
should be strong determination to the brain. 



766 MISCELLANEOUS DISEASES. 

Much may be done locally to afford relief, and hasten the 
cure. The means employed are sedative, anodyne, and 
revulsive applications, and depletory measures, either within 
the mouth or externally. Among these measures are 
brandy, or tincture of camphor, held for a short time in the 
mouth ; the chewing or smoking of tobacco ; poultices to 
the face, either simply emollient, or rendered anodyne by 
the admixture of laudanum, hops, etc.; anodyne lotions, as 
tincture of camphor with laudanum; rubefacient applica- 
tions, as capsicum, ginger, and mustard in the form of cata- 
plasms ; blisters to the side or back of the neck, or behind 
the ears ; steaming the face and head with the vapors of 
hot water ; scarification of the gums ; and, finally, leeches 
outside of the face or to the gums, when the inflammation 
is considerable, and it is deemed highly desirable to bring 
about resolution. In most cases, the milder of these means 
are abundantly sufficient ; as the disease is very generally 
soon relieved by suppuration, and the discharge of the pus. 
After the abscess has formed, it should be opened if it does 
not speedily discharge itself; and, when it occupies the 
substance of the cheek, care ,should be taken to make an 
early opening inwardly, lest it might break externally and 
leave an unsightly scar. 

When caries exists, in addition to the means just men- 
tioned, applications may be made to the cavity of the tooth 
itself. These are usually such as relieve pain by their ano- 
dyne, or obtund sensibility by their excessively irritant 
action. They consist chiefly of chloroform liniment, lauda- 
num or opium, in reference to the former effect; and of 
certain volatile oils, as those of cinnamon and cloves, in 
reference to the latter. The most efficient of these applica- 
tions, in the experience of the author, is creosote. Put un- 
diluted into the carious cavity, this substance not only 
relieves, but also for a time often effectually cures toothache. 
But as it speedily destroys the tooth, it should not be used, 
if it is desired to save it ; and great care is necessary to 
prevent it from coming in contact with the sound teeth, and 
injuring them. When liquids are employed, they should be 
introduced into the cavity on cotton. If opium is used, 



TOOTHACHE. 767 

care should be taken that the quantity be not so great as, 
if swallowed, to do serious injury. Various means have 
been used for destroying the nerve, the most certain of 
which is the arsenious acid. A mere speck of this should 
be introduced into the cavity and covered with beeswax. 
This causes no pain, and the amount is so small that no in- 
jury would follow if accidentally swallowed. 

When a tooth frequently becomes painful, and is too far 
gone to be saved, especially if the general health suffer, it 
should be extracted. In cases of dental fistulae, it is gene- 
rally advisable to remove the tooth, or such part of it as 
remains. The first teeth in children may be freely extracted, 
when carious and painful, as they are followed by others. 
But, in deciding as to the propriety of extraction, it should 
always be borne in mind that, when the permanent teeth 
are removed, the alveolar processes of the jaws are ab- 
sorbed, and the cheeks or lips fall in, producing an appear- 
ance' of old age. Besides, a carious tooth is often useful in 
mastication, in the intervals of pain. 

EHEUMATIC AND GOUTY TOOTHACHE. 

This is either neuralgic or inflammatory, and might have 
come, accordingly, under one or the other of the two pre- 
ceding heads. But there is something peculiar in its char- 
acter, which often serves to distinguish it from toothache of 
a different origin, and demands a somewhat peculiar treat- 
ment. It may, in general, be recognized by its occurrence 
in individuals of a rheumatic or gouty predisposition, by 
the simultaneous or immediately antecedent existence of 
these diseases in other parts of the body, by its extension, 
for the most part, through several teeth, or even the whole 
jaw, and by the fact that it is seldom or never attended 
with suppuration. The pain is, in the inflammatory variety, 
rather dull than acute. It is very apt to be induced by 
vicissitudes in the weather. It may occur either in carious 
or sound teeth. In addition to the local measures above 
enumerated, the constitutional treatment may be employed, 
which is applicable to other forms of rheumatism or gout ; 
and efforts may be made by stimulating pediluvia to invite 
49 



768 MISCELLANEOUS DISEASES. 

the disease, if thought advisable, to the lower extremi- 
ties. 

FALLING OF THE TEETH. 

The absorption of the socket, and consequent loss of the 
teeth, which is apt to occur in advanced life, is to be re- 
garded rather as a physiological than a morbid process. 
But, in consequence of certain diseases affecting the alveoli 
and gums, the teeth occasionally fall out prematurely, al- 
though not themselves apparently diseased. This happens 
in scurvy, in canker and gangrene of the mouth, and occa- 
sionally as a consequence of mercurial inflammation of the 
gums. I have never found so good a remedy for this dis- 
ease as the following : To a pint of good whiskey add an 
ounce of nutgalls, and thirty or forty drops of oil of pepper- 
mint ; wash the mouth with this freely several times a day ; 
and when the gums become considerably hardened, have 
the teeth cleansed of all incrustations, still continue the 
wash, and also use a soft brush ; and, as the gums harden, 
a stiffer one may be used. 

MUMPS PAROTITIS. 

Though named by nosologists from the parotid, this af- 
fection does not consist essentially in inflammation of the 
salivary glands ; as is sufficiently proved by the tendency 
to metastasis, and the contagious origin of the complaint ; 
both of which point to some change in the blood, or the 
presence in that fluid of some morbific agent, as the proba- 
ble cause of the local affections. 

Mumps usually begin with a feeling of stiffness about 
the joint of the jaws, which is followed by pain, heat, and 
swelling beneath the ear, but with little or no redness of 
the skin. The swelling rapidly extends in all directions, 
sometimes considerably down the neck ; and the other sali- 
vary glands are not unfrequently involved. The skin is 
somewhat tense, but the tumor is not very hard or elastic. 
When the swelling is at its height there is often great diffi- 
culty in opening the mouth, and sometimes deglutition is 
painful \ though frequently the latter symptom is quite 



mumps. 769 

wanting, and the complaint may thus be distinguished from 
angina or cynanche tonsillaris. There is generally more or 
less fever, but in most cases not sufficient to confine the 
patient. Sometimes, however, it is very high, with a furred 
or dry tongue, loss of appetite, heat of skin, and even some 
delirium. The inflammation usually reaches its highest 
point in two days, continues unabated until the end of the 
fourth, and then gradually declines, disappearing in about a 
week, with a disposition to perspiration in the neighboring 
parts, and sometimes over the whole surface of the body. 
The gland very seldom suppurates. I do not remember to 
have witnessed a case in which this result has occurred. 
When it does occur, the suppuration is said to be superficial. 
Sometimes only one parotid is affected, but more generally 
both, either simultaneously or successively. Not unfre- 
quently the inflammation of the salivary glands suddenly 
subsides, and the testicle or mamma becomes painful and 
swollen. A metastasis has taken place. This I have no- 
ticed to occur especially in young males approaching man- 
hood. When only one parotid has been affected, the testicle 
or mamma of the corresponding side generally becomes the 
seat of the translated disease. The labia pudendi in fe- 
males are said sometimes to be attacked. Generally, the 
new inflammation subsides in three or four days, without 
exhibiting any tendency to suppuration. In some instances 
it suddenly returns to the parotid, leaving the mamma and 
testicle sound. Translation may also take place to other 
organs. There is reason for the conjecture that the pancreas 
is thus sometimes affected. That a metastasis to the brain 
occasionally takes place is well known. This is,' indeed, the 
chief danger of mumps, and sometimes ends in death. The 
disease is usually exceedingly mild, and almost never ter- 
minates fatally, unless under the circumstances just al- 
luded to. 

Contagion is undoubtedly a frequent cause of mumps ; 
but there is reason to believe that the disease also sometimes 
originates from epidemic or endemic influences, independ- 
ently of contagion, though, when thus produced, it is equally 
capable of self-propagation as if it had arisen in the ordinary 



770 , MISCELLANEOUS DISEASES. 

way. It occurs most frequently in the young, and more 
frequently in males than females. Like most other conta- 
gious affections, it seldom attacks the same individual more 
than once. Occasionally, however, it does so. Many per- 
sons escape it altogether. 

In most cases of mumps, little treatment is requisite. It 
is usually sufficient for the patient to live low, and avoid 
exposure to cold and wet. Should the howels be confined, 
refrigerant laxatives, as the seidlitz powder, or small doses 
of one of the neutral salts, should he given occasionally. 
All repellant applications to the tumor should he scrupu- 
lously avoided, for fear that a metastasis may take place. 
It is indeed advisable to keep the parts warm, so as to pre- 
vent the repellant influence of the external cold, and to 
favor a tendency to perspiration. This is peculiarly appro- 
priate in the present affection, in consequence of the absence 
of all disposition to the suppurative process. Singed tow 
is a popular and very suitable application ; but carded wool 
or cotton, or a piece of soft flannel, may be substituted. If 
the inflammation should be considerable, and fever exist, 
the saline cathartics may be given more freely ; and, if the 
fever should be high enough to confine the patient to bed, 
the antimonials, and other refrigerant diaphoretics, may be 
added to the other measures. 

Should the inflammation be translated to the mamma or 
testicle, warm emollient poultices should be applied. But 
if the local affection is considerable, leeches should be freely 
applied, especially to the testicle. In the cases of young 
and vigorous men, it is sometimes proper to bleed generally, 
as well as locally. The patient should be confined to the 
horizontal posture, the testicle should be sustained by a 
suspensory bag or other means, and emollient applications 
should be made after leeching. At the same time it is ad- 
vised to endeavor to recall the inflammation to the parotid 
by some stimulating application, as a sinapism or blister 
over the gland. 

In case of metastasis to the brain or other vital organ, 
antiphlogistic measures should be energetically employed, as 
in inflammation of these organs from other causes. 



PILES. 771 

When much suffering is experienced from the swollen 
gland, an application of the chloroform liniment will usually 
allay it in a few minutes. 

HEMORRHOIDS, OR PILES. 

This term has been applied both to hemorrhages from 
the rectum, and to certain tumors which form in and about 
the anus. In the former case, whether the hemorrhage is 
or is not accompanied with tumors, the affection is called 
bleeding piles ; in the latter, when unconnected with any 
discharge, blind piles. The tumors are also distinguished 
into internal piles, which are within the sphincter ani, and 
external piles, which are without the sphincter. I shall pay 
little attention to these distinctions in the following remarks. 
Simple bleeding from the rectum, independent of tumors, 
though it may proceed from the same pathological condition 
as that which gives rise to the tumors, falls properly among 
the hemorrhages, and has been considered with them. I 
shall here speak of the hemorrhage only as an attendant or 
result of the tumors. * 

Hemorrhoidal tumors are not entirely identical in cha- 
racter. The following varieties may be distinguished : 
1. The simplest form is that of varicose hemorrhoidal veins, 
consisting in a mere distention of the coats of the vessel, as 
in varicose veins of the leg. The same vessels are affected 
in the external and internal piles, the veins above and 
below the sphincter being continuous, and not suffering 
dilatation in general at the sphincter, because compressed 
by that muscle. In their simplest state, these tumors are 
full of liquid blood, and may be readily evacuated by 
pressure, to be filled again immediately upon the removal 
of the pressure. After death they frequently disappear 
entirely, but may be rendered evident by injecting the 
inferior mesenteric vein. 2. The varicose tumors, in con- 
sequence of inflammation, or from rupture and consequent 
effusion of blood, undergo various changes producing a solid, 
vascular, hard, or more or less spongy tumor. 3. Instead of 
being varicose, the tumors sometimes consist of a sort of 
erectile tissue, which may be supposed to be formed by the 



772 MISCELLANEOUS DISEASES. 

opening of communications between contiguous venous and 
perhaps arterial radicals, and between both and the cellular 
tissue, which assumes a denser and firmer character, 
exhibiting numerous interlacing fibres. 4. Fleshy tumors 
may originate from the altered varices described above, by 
the organization of the coagulated blood in their centre, or 
its absorption and the deposition of organizable lymph. Or 
they may be produced, as Burne suggests, by a circum- 
scribed thickening of the submucous cellular 'tissue, which, 
thus projecting somewhat into the cavity of the. rectum, is 
carried down during defecation, and, being arrested by the 
contraction of the sphincter, becomes inflamed and enlarged, 
so as not to admit of return. 5. These tumors may, by 
the influence of adhesive inflammation and subsequent 
absorption, be converted into dry, hard, indolent, wart-like 
projections in or near the anus ; and, even though originating 
under the mucous membrane, may be covered with skin, in 
consequence of a not unfrequent transformation of that 
membrane when prolapsed and exposed long to the air. 
Another sequela of the proper hemorrhoids consists in folds 
of the mucous membrane or skin in or near the anus, result- 
ing from the absorption of the contents of previous tumors. 
The phenomena of piles are somewhat different, accord- 
ing as they are external or internal. In the external piles, 
a tumor is observed on the verge of the anus, of greater or 
less extent, sometimes on one side only of the aperture, 
sometimes completely surrounding it, and in the latter case 
usually presenting an unequal outline, as if consisting of 
several tumors separated by shallow furrows. The con- 
sistence and color of the tumor vary according to its cha- 
racter. If varicose, it is of a violet color, soft, and more 
or less removable by pressure; if fleshy, it is of a red 
color, solid, firm, and elastic. It has usually a broad base, 
and the fleshy tumor is often elongated from before back- 
ward, in consequence of being pressed, on each side by the 
buttocks. When inflamed, these piles are peculiarly incon- 
venient by interfering with exercise in almost every way, 
and even with sitting. The internal piles are attended 
with a sense of distention which provokes a constant dispo- 



piles. 773 

sition to go to stool, and are peculiarly painful during the 
act of defecation. At first, though they are apt to descend 
at each evacuation, they usually return spontaneously when 
straining ceases ; but after having acquired a certain magni- 
tude, they can be restored to their position within the 
sphincter, after protrusion, only by the aid of the finger of 
the patient. When without the sphincter, they are rendered 
very painful by its contraction, but become comparatively 
easy when returned. After a time they descend when the 
patient walks or stands, especially if the rectum is full, and 
great inconvenience is experienced from the irritation and 
excoriation to which they are subjected. When thus 
extruded, they are sometimes strangulated by the sphincter, 
and become in consequence so much inflamed and swollen, 
that the patient cannot himself restore them, and even the 
surgeon finds considerable difficulty. Occasionally, in this 
condition, they burst, and by the discharge of blood are so 
much diminished in size, and relieved, as to admit of easy 
reduction. In other cases they swell enormously, become 
gangrenous, and, after having occasioned vast suffering and 
inconvenience to the patient, slough off, and terminate 
finally in a radical cure. There are the same differences 
in color and consistence in the internal as in the external 
piles. The fleshy tumors are sometimes narrow at the 
base, and bear no inconsiderable resemblance to polypi of 
the rectum. 

Both the internal and external piles occasionally suppu- 
rate, forming abscesses or ulcers, which are often very 
troublesome, ending sometimes in the establishment of 
fistulae, though in other cases they eventuate more favor- 
ably, and even lead to a permanent cure. 

More or less hemorrhage often attends defecation, the 
blood proceeding either from the abraded mucous coat, or 
from a rupture of the tumor, or from an oozing over its 
whole surface in an inflamed state. In general, the bleed- 
ing is very slight, not more than sufficient to tinge the 
faeces. But it is sometimes copious, and, in a few compara- 
tively rare cases, very much so, producing by its frequent 
returns, and the quantity discharged at each time, an 



774 MISCELLANEOUS DISEASES. 

alarming and dangerous anemic condition of the patient. 
Some individuals are liable to periodical attacks of this 
hemorrhage, corresponding probably with the periodical 
returns of the hemorrhoidal congestion ; and it is not always 
easy to decide whether the bleeding is or is not connected 
with the tumors. The blood sometimes collects in large 
quantities in the rectum before being discharged. It is in 
some instances venous, in others arterial; being of the 
former character probably when proceeding from a ruptured 
tumor, and of the latter when from other sources. 

The general health often suffers very severely from long- 
continued and aggravated piles. Preventing exercise, and 
rendering necessary an almost constant use of medicines 
which interfere more or less with digestion, they lead to 
the production of dyspepsia with all its train of evils, and, 
besides, call numerous organs into a direct sympathy which 
cannot but impair their functions. Paleness, emaciation, 
and mental irritability or dejection, or at least a very 
uncertain condition of the feelings, are among their frequent 
concomitants. 

Causes. — These are such as either produce congestion in 
the rectum, or act with an immediate mechanical violence 
upon its lower extremity. The former may be constitu- 
tional or local. Among the constitutional, the most com- 
mon is probably a plethoric state of the blood-vessels, 
induced by a rich, nutritious, and stimulating diet, or simple 
excess in eating, conjoined with sedentary habits. Gouty 
and rheumatic irritation sometimes finds expression in a 
congested state of the hemorrhoidal vessels. The suppres- 
sion of habitual discharges, such as that of the menses, 
sometimes leads to the same result. Hereditary predispo- 
sition has also been considered as one of the remote causes 
of piles, and there can be little doubt that a constitution of 
the system favorable to this disease occasionally descends 
from the parent to the offspring. Of the local causes, those 
are most efficient which by any means tend to check the 
return of blood from the hemorrhoidal veins. Torpidity 
and congestion of the liver often occasion piles, by im- 
peding the return of the blood of the portal circulation 



piles. 775 

through the capillaries of that organ; and hepatic indura- 
tion or enlargement may have the same effect, either in the 
same way, or by narrowing the ascending vena cava. 
Pregnancy, by mechanical pressure upon the returning 
veins,' and a long continuance in the erect position, by the 
effect of gravitation, often cause a distention of the hemor- 
rhoidal vessels that results in piles. To the above list may 
be added all causes of irritation of the rectum, whether 
direct or indirect, such as acrid purgatives and especially 
aloes, irritating injections, the frequent use of suppositories, 
acrid alvine evacuations, ascarides, violent jolting on horse- 
back, dysentery, inflammation of the prostate or of any of 
the pelvic viscera, and venereal excesses. The causes 
which act by mechanical violence are long and severe 
straining at stool, and the difficult passage of hard fecal 
matter through the anus. But piles probably have their 
origin more frequently in constipation of the bowels than in 
any other source. This operates in various ways in pro- 
ducing them, but chiefly by the pressure of the accumulated 
and hardened faeces upon the returning veins, and by the 
straining, violent compression, irritation, and even laceration 
they occasion during their evacuation. 

Piles are very rare in children before the age of puberty, 
and are most common between the thirtieth and fiftieth year. 
Males are more subject to them than females, if we leave 
out of consideration pregnant women, in whom they are very 
frequent. 

Treatment. — In relation to the treatment of piles, it is 
proper first to consider what effect their cure may have upon 
the general health, and how far we may venture upon their 
removal with safety. They have been considered as an 
outlet through which various morbid tendencies were allowed 
to expend themselves, and the premature closure of which 
might bring these tendencies into injurious action elsewhere. 
There can be little doubt that this opinion is in some degree 
true. The hemorrhoidal effort depends on a general disor- 
dered condition, which, if not directed to the rectum, would 
find some other point upon which to expend its force. This 
is the case whether the piles are or are not attended with a 



776 MISCELLANEOUS DISEASES. 

discharge of blood. But when bleeding from the hemor 
rhoidal tumors has been frequent, long-continued, and con- 
siderable, there is the additional consideration, that the sys- 
tem has in some measure accommodated itself to these 
discharges, and, in order to supply the loss, it has acquired 
the habit of elaborating blood more rapidly, so that the 
danger of plethora from their arrest would be superadded 
to that of the morbid tendency in which the piles originated. 
The complaints which are most to be feared from the cure 
of piles are apoplexy and pulmonary hemorrhage; and 
when a predisposition to these affections is known to exist, 
it should always be allowed to have some weight in the 
decision of the practical question. But as piles themselves, 
when severe, sometimes materially interfere with the general 
health, it is necessary to weigh carefully the opposing con- 
siderations, and to strike the balance between them. Should 
the danger of the very serious complaints above alluded to 
seem to outweigh the inconvenience of the hemorrhoidal 
affection, and its direct injurious influence on the health, it 
will be better to confine our efforts to the alleviation of 
the symptoms than to attempt a radical cure ; and, in cases 
in which the latter course is pursued, the propriety is obvi- 
ous of counteracting the morbid tendencies by a proper 
regulation of the diet, and the use of suitable depletory or 
revulsive means, as bleeding, saline purgatives, and blisters 
or issues. In all instances, however, where the hemorrhoids 
are purely a local affection, they cannot be treated too 
promptly ; and the number of cases is comparatively few 
in which, though connected with some constitutional derange- 
ment, they may not be removed with safety, if care be taken 
to obviate the possible evil by suitable precautionary measures. 
So far as the treatment is directed to the removal of the 
causes, it may be carried into effect without the least hesi- 
tation. 

In the medical treatment of piles, the first object is to 
remove the causes. Attention should therefore be paid to. 
the condition of the system, and any existing plethora or 
general excitement, which may act as a predisposing cause, 
should be corrected by saline cathartics, and an antiphlogistic 



piles. 777 

regimen. One or two doses of sulphate of magnesia, and 
a diet exclusively of vegetable food, will often be sufficient 
to relieve that hemorrhoidal effort of system, and conse- 
quent congestion of the rectum, which lead to a paroxysm 
of piles. 

As constipation is the most productive cause of piles, so 
its removal is the most important indication; and the com- 
plaint may often be effectually cured by keeping the bowels 
regularly open, and the feculent discharges in a soft, unirri- 
tating condition. This is best done by a proper regulation 
of the diet, and by the use of mild laxatives. (See Con- 
stipation.) Among the best of these are cream of tartar 
and sulphur, equal parts ; or confection of senna and sul- 
phur, which may be given separately or together, and may 
be usefully combined with bitartrate of potassa when the 
tumors are inflamed. The laxative may be given at bed-time, 
so as to operate gently in the morning. 

In connection with the use of laxatives, attention should 
be paid to the correction of those habits of the patient 
which tend to produce and maintain the disease. High- 
seasoned food, alcoholic drinks, and strong coffee should be 
avoided; moderate exercise should be taken both on foot 
and on horseback ; the patient should not sit habitually on 
soft cushions, nor sleep too warmly in feather beds ; the use 
of acrid purgatives, especially those containing aloes, of 
warm emollient or stimulating enemata, and of the warm 
hip-bath, should be discouraged ; and care should be taken 
to correct torpor or congestion of the liver, if this be one 
of the complications of the case. Acrid secretions should 
be removed by castor oil, and acid in the bowels by mag- 
nesia. Irritations in the bowels or neighboring pelvic 
viscera should be corrected as far as possible, and those 
practices carefully shunned which tend to produce such 
irritatioDS. 

While removing the causes of piles, we may also advan- 
tageously direct our remedies immediately to the seat of 
disease. One of the most efficacious means of cure is the 
injection daily, after the bowels have been evacuated, of 
half a nint or more of cold water into the rectum ; and by 



778 MISCELLANEOUS DISEASES. 

a perseverance in this plan for several months, with the use 
of laxatives if required, cures have been effected even in 
very unpromising cases. Care should be taken not to irri- 
tate the rectum by an unskilful introduction of the pipe. 
Sponging the anus with cold water every morning and eve- 
ning will also be found useful. 

Should the tumors be inflamed, rest in a horizontal pos- 
ture, with lotions of cold water, or lead-water; and, when 
the pain is very severe, liniments, ointments, or cataplasms 
containing opium, hyoscyamus, belladonna, or stramonium, 
or decoctions of poppy-heads or hops, should be, employed. 
These anodyne applications are not only useful by allaying 
pain, but contribute to a cure by obviating the tenesmus 
and straining, which tend so strongly to sustain and aggra- 
vate the complaint. When the inflammation is not acute, 
benefit may sometimes be obtained from astringent applica- 
tions. Ointment of galls with opium may be used when 
the tumors are external ; decoction of galls or oak bark, or 
infusion of catechu or kino, when they are internal. If the 
internal piles have protruded, and do not return of them- 
selves, and cannot be returned by the patient, the practi- 
tioner must endeavor to reduce them by placing the patient 
on his hands and knees, anointing the parts well with unc- 
tuous matter, then making gentle and uniform pressure, so 
as to force out the blood, and, lastly, introducing by his 
hands the diminished tumor within the sphincter. Should 
he not succeed by these means, he may apply cold water to 
the part in order to produce contraction, or let out the 
blood by means of needles or a lancet, and then restore the 
piles. In cases where strangulation and gangrene have 
taken place, poultices with laudanum should be applied 
locally, and the patient kept under the influence of opiates, 
with wine, quinia, and a nutritious diet, if necessary to sup- 
port his strength. 

When the hemorrhage is so copious as to require treat- 
ment, if it be acute, the patient should lie on his back, cold 
water should be injected into the rectum, and applied exter- 
nally, and nitre with antimonials, or the acetate of lead, given 
by the mouth. If these measures fail, a solution of alum 



PHLEGMASIA DOLENS. 779 

or a strong vegetable ' astringent infusion, or the two com- 
bined, may be used in the form of enema. In more chronic 
cases, the same astringents may be employed, and recourse 
may at the same time be had to the internal use of oil of 
turpentine, in the dose of from fifteen to thirty drops three 
or four times a day, or of copaiba in the same dose, or of 
ergot to the amount of two scruples or a drachm daily in 
divided doses. The oil of turpentine has been especially 
lauded in obstinate cases of hemorrhoidal flux. 

When other means fail, and the health of the patient 
suffers, or the inconvenience of the tumors is very great, 
recourse may be had to their extirpation either by the knife 
or ligature, or by both united. The evacuation of the 
tumors by incision, or by the removal of a portion of their 
summit by the bistoury or a pair of bent scissors, and their 
destruction by different caustics or the actual cautery, are 
modes of cure which have had their advocates. 

Should the cure of piles be found to have occasioned any 
serious injury to the health, endeavors should be made to 
restore the hemorrhoidal disease by aloetic purgatives, irri- 
tating injections, and the use of the warm hip-bath. 

PHLEGMASIA DOLENS MILK-LEG. 

This affection occurs generally in women after delivery, 
but sometimes also in those who are unmarried, and occa- 
sionally even in males. It usually commences about a 
week or two after delivery, though the interval may be 
much longer. In some instances it is preceded by febrile 
symptoms, in others is ushered in with a chill occurring 
simultaneously with the local affection, and in others 
again, and these are the most numerous, commences with 
pain. This is usually felt first in the loins or lower part of 
the abdomen, whence it extends to the groin, and thence to 
the vulva, and down the thigh and leg. In some instances, 
however, it shows itself first in the lowest part of the limb, 
travelling upwards, and in others in two distant points at 
the same time. At first it may only be an aching sensa- 
tion with soreness, and a sense of weight or stiffness in the 
part ; but it soon increases and becomes acute ; severe, and 



780 MISCELLANEOUS DISEASES. 

sometimes even excruciating, being felt most along the 
course of the internal cutaneous and crural nerve in the 
thigh, and of the posterior tibial in the leg. The limb soon 
begins to swell, and in the course of forty-eight hours is 
sometimes of twice its usual dimensions. The* labium 
pudendi is similarly affected. With the swelling, the acute- 
ness of the pain generally abates in some measure, but the 
soreness continues, and is much aggravated by every move- 
ment. The limb is in general slightly flexed, and quite 
motionless as if paralyzed. The swelling, when at its 
height, is uniform over almost the whole limb, which is of 
an unnatural whiteness, shining, hot, and firm and elastic to 
the touch. It does not pit upon pressure, except some- 
times at the commencement and the decline of the swelling. 
When cut, it exudes only a small quantity of fluid. Some- 
times red lines are observed in the course of the crural 
veins, and red patches here and there upon the limb ; but 
the color, as just stated, is usually white. The tenderness 
is greatest along the femoral vein, which may almost always 
be felt like a hard cord. Sometimes this hardness is con- 
fined to the groin, sometimes may be felt all the way down 
the thigh and leg, and in other instances occurs in distinct 
parts of the course of the vessel. The uniformity of the 
cord is interrupted by occasional nodules, arising either 
from inflamed cellular tissue, or coagula in the cavity of the 
vessel. The lymphatic glands of the groin are usually 
hard and swollen. Both limbs are seldom attacked at the 
same time; bu,t it sometimes happens that one becomes 
affected after the recovery of the other. The left is more 
frequently attacked than the right. 

The, disease is said sometimes to extend to the arm of 
the affected side. It is attended with a very frequent 
pulse, often with nausea and vomiting, and other febrile 
symptoms, and sometimes with suppression of the lochia 
and the milk. 

Phlegmasia dolens generally terminates favorably, though 
constitutional symptoms occasionally make their appearance, 
such as have been ascribed to the entrance of pus into the 
circulation, and the patient sinks. The acute symptoms 



PHLEGMASIA DOLENS. 781 

are in most cases over in two weeks ; but the limb often 
continues more or less swollen or hard, for a long period, 
sometimes even for life. In favorable cases, the symp- 
toms gradually subside ; the pain, hardness, and swelling 
abate ; and the blood, which can find no passage through 
the large internal veins of the limb, is returned by the 
superficial vessels, greatly enlarged for the purpose. Some- 
times erysipelatous inflammation occurs in the limb, and 
abscesses form in different parts of it, as well as in differ- 
ent parts about the pelvis, greatly increasing the danger of 
the patient, and, in some instances, proving fatal. 

Affections in most respects identical with phlegmasia 
dolens have been observed in women after abortion, and in 
others affected with malignant ulceration or other organic 
disease of the unimpregnated uterus, or in whom that 
organ has suffered violence, as from the application of the 
ligature for the removal of polypus. Men, too, have been 
similarly affected in consequence of organic disease in the 
pelvic viscera, or injury inflicted on these parts. The same 
thing has also been observed in dysentery and fever. 

Treatment. — The pulse in this disease is not usually 
strong enough to call for the lancet, but leeches along the 
affected vein are of the greatest importance. They- should 
not only be applied once, but should be repeated over and 
over again, if the symptoms of inflammation should perse- 
vere; they are in general most effectively applied in the 
groin and upper part of the thigh, over the femoral vein ; 
but they should also follow the track of the tender and 
hardened vessel, wherever it can be traced. The leeches 
may be followed by cold saturnine lotions, applied by means 
of linen cloths, or by warm fomentations and emollient 
cataplasms, according as one or the other of these measures 
is found most comfortable to the patient. The local vapor 
bath has sometimes proved salutary. To relieve the very 
severe pain, anodyne substances, such as the preparations 
of opium, hyoscyamus, belladonna, conium, stramonium, or 
hops, may be incorporated with the refrigerant or emollient 
applications. Perhaps no remedy will be found to act more 
promptly in relieving the pain, as well as in subduing the 



782 MISCELLANEOUS DISEASES. 

inflammation, than the chloroform liniment freely sprinkled on 
cloths wrung out of a warm infusion of mullen leaves. When 
the bowels are not already too much disturbed, as not unfre- 
quently happens in bad cases of the disease, saline cathar- 
tics may be employed, alternated with diaphoretic doses of 
tartar emetic, the neutral mixture, and other internal re- 
frigerant remedies. Should the disease not seem disposed 
to yield, calomel or the blue-pill may be given, in combina- 
tion with opium or hyoscyamus. Throughout the com- 
plaint, it is often necessary, or at least advisable, to control 
the severe pain and relieve restlessness by anodynes, and 
especially opium, which may be combined with ipecacuanha 
in the earlier stages. After the subsidence of the violent 
symptoms, if the swelling should remain hard, and appear 
disposed to assume an indolent character, blisters should be 
employed ; and when leeches cannot be procured, they may 
be resorted to at an earlier period. A spare diet, and per- 
fect rest of the limb in the horizontal position, are also 
essential parts of the treatment. When great prostration 
comes on, it is necessary to support the system by stimu- 
lant remedies and a nutritious diet. Wine-whey, and ani- 
mal broths and jellies, are now appropriate ; and these 
general measures may be employed, even though it may 
appear proper to make efforts for the relief of the inflam- 
mation by local depletion. The fever syrup is peculiarly 
appropriate in this stage of the disease, either alone or com- 
bined with quinine. 

During convalescence, care should be taken not to employ 
very energetic measures for hastening the reduction of the 
tumefaction. Time is required for the sufficient enlarge- 
ment of the new T veins, through which the blood must make 
its exit from the limbs. Premature irritation might en- 
danger an increased inflammation of the part. But, with 
this caution, ointments of iodine or mercury, or of both, 
may often be usefully applied with the view of promoting 
absorption ; and blisters may be resorted to with the same 
object. Should considerable oedema remain, it may gene- 
rally be corrected by bandages, and the use of diuretics, 
such as squill and bitartrate of potassa. 



DYSPHONIA CLERICORUM. 783 



FATTY DEGENERATION OF THE KIDNEY BRIGHT S DISEASE. 

In 1827, Dr. Bright first pointed out the frequent con- 
nection of anasarca and other dropsical affections with a 
peculiar disease of the kidneys, the prominent character of 
which is the appearance of albumen in the urine, and the 
deposition of a peculiar granular matter in the substance of 
the renal gland, together with the gradual atrophy of its 
cortical and tubular structure. Hence this affection is com- 
monly known as Bright' s disease, or as granular degeneration 
of the kidney. The investigations thus commenced have 
now been perfected by Dr. George Johnson, and I avail 
myself of his labors. 

The appearances in the urine which characterize this dis- 
ease are — a scanty secretion, which is highly albuminous, 
and of low specific gravity; it is generally, in the early 
stages, free from sediment. After a period, variable in dif- 
ferent cases, while the general characters of the urine re- 
main unaltered, there appears a light, cloudy sediment. 

The chief symptoms produced by this disease are — gradu- 
ally increasing debility; inflammation of the serous mem- 
branes ; anasarca of the limbs, with dropsy of the different 
cavities ; and ultimately coma, which soon ends in death. 
It is often the consequence of acute nephritis ; or it may 
arise from scrofula, bad living, constant exposure to cold 
and wet, intemperance, etc. 

In the treatment, we can do little more than relieve symp- 
toms. The diet should be regulated ; and abstinence from 
intoxicating 'drinks, starch, sugar, and perhaps fatty articles 
of food, insisted upon. In other respects, the rules laid 
clown in dyspepsia must be attended to. 

DYSPHONIA CLERICORUM CLERGYMAN'S SORE THROAT. 

Dysphonia clericorum, or clergyman's sore throat, is fre- 
quently a nervous complaint, being unattended, at least in 
its early stages, by any organic lesion, but consisting rather 
of irritation of the investing membrane of the fauces. 
Subsequently, however, a series of morbid changes takes 
place, such as congestion, inflammation, or relaxation of the 
50 



784 MISCELLANEOUS DISEASES. 

mucous membrane, enlargement of the tonsils, elongation 
of the uvula, and irritation, inflammation, morbid deposit, 
and ulceration of the mucous follicles. Dr. Horace Green, 
of New York, has described this affection when far ad- 
vanced as consisting of a diseased condition of the glandu- 
lar follicles of the mucous membrane of the throat and 
windpipe, commencing usually in the mucous follicles of the 
isthmus of the fauces and of the upper portion of the 
pharyngeal membrane, and extending by continuity until 
the small glands of the epiglottis, larynx, and trachea are 
extensively involved in the morbid action. He calls it fol- 
licular disease of the pliaryngo-laryngeal membrune. 

Symptoms. — These consist of an uneasy sensation in the 
upper part of the throat, with continued inclination to 
swallow, as if there were some obstacle in the oesophagus 
which could be removed by deglutition. The patient also 
makes frequent attempts to clear the throat of phlegm by 
coughing, hawking, and spitting ; he will point to the larynx, 
too, as being the seat of pain. At the same time, the voice 
undergoes an alteration ; there is loss of power and hoarse- 
ness ; sometimes complete aphonia, especially towards the 
evening. On examining the throat and fauces, we shall 
find these parts presenting an unhealthy, slightly raw or 
granular appearance ; the mucous follicles will be visible, 
sometimes filled with a yellowish substance, and a viscid 
muco-purulent secretion will be seen adhering to the palate 
and to the edge of the velum pendulum palati. 

This sore throat may exist alone, or it may accompany 
or follow laryngitis, bronchitis, or phthisis. Clergymen, 
public speakers, actors, singers, etc., are most liable to it. 

Treatment. — In its early stages, when merely a nervous 
affection, the treatment must consist in the use of tonics, 
especially iron and quinine, cold shower-baths or sea- 
bathing, and temporary change of scene and occupation. 
When the disease is further advanced, a combination of 
internal with local remedies will be necessary. Iodide of 
potassium, iodide of iron, iodide of zinc, tonics, and opiates, 
will prove of advantage ; but the best internal remedy, 
according to my experience, is the combination of iodide of 



INTESTINAL WORMS. 785 

potassa with sarsaparilla. and fever syrup, recommended in 
scrofula. The local treatment consists in the application of 
a solution of nitrate of silver (two to four scruples to the 
ounce of distilled water) to the diseased *parts. When the 
tonsils remain enlarged and indurated, as they often do 
after this disease, as well as after tonsillitis, various astrin- 
gent gargles and inhalations, preparations of iodine, and the 
solid nitrate of silver have been employed. Not unfre- 
quently, permanent and effectual relief will only be obtained 
by the excision of one or both of these glands. 

But it is much easier to prevent the formation of this 
disease than to cure it; w r hich may easily be done by 
observing the precaution of avoiding any unnecessary strain 
upon the vocal organs. If the voice be made to keep 
within the limits of an octave in music, no injury will be 
sustained, however loud and strong the tone may be. But 
if the speaker cannot retain sufficient presence of mind to 
control his voice within proper limits, or to regulate his 
tones by the musical scale, and should find on ceasing 
that some uneasiness has been created about the throat, he 
should not adopt the absurd practice of enveloping his neck 
with a large handkerchief, or shawl, and by sweating pro- 
duce still further debility and relaxation, as this will 
inevitably invite congestion, which will easily be converted 
into irritation or inflammation; but, on the contrary, let 
him at once apply cold water to the throat, and then rub it 
with a dry cloth until some redness is produced. If these 
simple directions are followed, no fear need be entertained 
of this very annoying disease, which is yearly driving from 
the pulpit many of its brightest ornaments and most effi- 
cient laborers. 

INTESTINAL WORMS. 

There are five species of worms occasionally found inha- 
biting the intestinal canal; of which three possess an 
alimentary tube, and are therefore called hollow worms, and 
two which have no abdominal cavity, and hence termed 
solid worms. 



7S6 MISCELLANEOUS DISEASES. 

In the first class we have — 

1. The long thread-worm, usually found in the coecum 
and large intestines, measuring about two inches in length, 
and having a very slender body. It is often found in con- 
siderable numbers, even in the intestines of healthy persons. 

2. The large round-worm is found in the small intestines, 
especially of ill-fed children. It somewhat resembles in 
size the common earth-worm, varies in length from six to 
nine inches, and is of a light-yellow color. Although the 
usual habitation of this worm is the small intestines, yet it 
may pass into the stomach and downwards into the colon ; 
and consequently be vomited in the one case, or passed 
with the stools in the other. Sometimes these worms are 
very numerous. The symptoms which it gives rise to are 
thirst, disturbed sleep with grinding of the teeth, pallid 
countenance, fetid breath, swelled belly, emaciated extremi- 
ties, depraved appetite, slimy stools, itching of the nose, 
tenesmus, and itching of the anus. 

3. The small thread-worm is found in the rectum, and is 
the smallest of the intestinal worms, averaging usually 
about a quarter of an inch in length. It gives rise to 
intolerable itching and irritation about the anus, tenesmus, 
depraved appetite, picking of the nose, depraved breath, and 
disturbed sleep. 

In the second class we find — 

1. The common tape-worm of this country, which exists 
in the small intestines, varying in length from ten to one hun- 
dred feet, and in breadth from one line, at its narrowest part, 
to four or five at its central or broadest portion. The head 
of this parasite is small and flattened, having in its centre 
a projecting papilla, armed with a double circle of hooks, 
around which are four suckers or mouths, by which nourish- 
ment is imbibed ; the generative apparatus consists of a 
ramified canal or ovarium containing the ova, and occupying 
the centre of each joint. The symptoms of its presence 
are not very striking, its existence being generally unsus- 
pected until single joints are passed in the stools ; in many 
cases, however, there is a continual craving for food, 




LONG TAPEWORM. (Tamia solium.) 




TRICHINAE. {Tricocephalus dispar.) 



INTESTINAL WORMS. 787 

debility, pain in the stomach, emaciation, and itching about 
the nose and anus. 

2. The broad tape-worm is almost peculiar to the inha- 
bitants of Switzerland, Russia, and Poland. It differs 
from the common tape-worm in having its segments of a 
greater breadth than length. It is very rarely met with in 
this country, but is so occasionally. 

Symptoms. — The most common symptoms produced by 
these worms are — colicky pains and swelling of the abdo- 
men ; picking of the nose ; itching of the rectum and funda- 
ment; foulness of the breath; irregular bowels; grinding 
of the teeth at night; and voracious or impaired appetite. 
The most conclusive sign is the passage of some of the 
worms or joints of them in the fseces ; and indeed without 
this, the other symptoms are but of little value. 

Treatment. — Two indications are presented : first, to expel 
the worms from the bowels ; and, secondly, to prevent their 
reproduction. 

The first indication may be fulfilled by active purgatives, 
which expel them by the increased activity they give to 
the peristaltic movement, or by anthelmintic medicines, 
which favor their expulsion through the ordinary contrac- 
tion of the bowels, by rendering them less able or less 
disposed to resist this contraction. But a more effectual 
plan is to combine these two modes, thus at the same time 
bringing a greater force to bear upon the worms, and 
diminishing their powers of resistance. The purgatives and 
anthelmintics may be given conjointly ; or the latter may 
be administered night and morning for a few days, and then 
followed by the former. 

Anthelmintics are medicines which prove disagreeable to 
the worms, and thereby dispose them to leave the bowels, 
or so debilitate them as to disable them from maintaining 
their position, or finally destroy them, and thus expose 
them to the expulsive powers of the intestines, or the 
digestive powers of the stomach. They may produce these 
effects by acting on the susceptibilities of the worm as 
medicines and poisons act on the human system, or by 
mechanically bruising or wounding it. Among those which 



788 MISCELLANEOUS DISEASES. 

operate in the former method may be mentioned, pink-root ^ 
male fern, the bark of pomegranate root, walnut-rind, common 
salt, camphor, various bitters, and numerous substances cha- 
racterized by containing a strongly odorous or highly 
stimulating volatile oil, as turpentine, copaiba, savine, cheno- 
podium or American wormseed, tansy, rue, wormivood, garlic, 
and assafcetida. Several of the volatile oils themselves 
are still more efficacious, especially the oil of turpentine and 
that of chenopodium. Electricity passed through the bowels, 
in successive and somewhat violent shocks, has been sup- 
posed to injure or kill the worms, and favor their expulsion 
by cathartics. The mechanical anthelmintics are chiefly 
cowhage, which wounds and sometimes destroys the worms 
by the sharp bristles of its pods, and the powder of tin or of 
zinc, which bruises or scratches them by its angular particles. 

In the choice of purgatives, attention should be paid to 
their anthelmintic properties. Thus, calomel is a powerful 
vermifuge, much more so than can be satisfactorily explained 
by a reference to its mere cathartic power. The probability 
is, that it proves disagreeable or injurious to the worm by 
the acrid property of the bile which it causes to be 
secreted. Aloes is also thought to possess vermifuge pro- 
perties, independently of its purgative action, owing to its 
intense bitterness ; this property being considered by some 
as extremely offensive to worms. The same may be said 
of colocynth. The oil of turpentine in very large doses, and 
the bark of pomegranate root, unite purgative and anthel- 
mintic powers. Considered independently of anthelmintic 
properties, those cathartics are the most powerfully vermi- 
fuge which act with greatest energy on the muscular coat 
of the bowels. Senna, jalap, scammony, aloes, colocynth, 
gamboge, croton oil, and elaterium have been used, variously 
combined, and in various modes of preparation ; but, except 
in very obstinate cases of worms, it is better to trust to the 
proper anthelmintics, with the less violent of these cathar- 
tics, than to endanger inflammation of the bowels, or 
exhaustion of the patient, by a resort to the most energetic. 

To meet the second indication, that, namely, of preventing 
the reproduction of the worms when once destroyed or 



INTESTINAL WORMS. 789 

evacuated, it is necessary to attend to the food and drink 
of the patient, and, if the digestion is feeble, to promote 
that function by tonic medicines, exercise, and other suit- 
able measures. Excess in eating, indigestible substances, 
unwholesome food of all kinds, and unwholesome drinks, 
should be avoided. Of the tonics, the different preparations 
of iron are probably the most efficacious, though they may 
be advantageously combined with the simple bitters, as gen- 
tian, quassia, and columbo. The bitters in which the tonic 
principle is associated with an anthelmintic volatile oil, as 
wormwood, tansy, and rue, were formerly much used, and 
are probably not without a peculiar efficacy. I have known 
several families in which the younger members were regu- 
larly given worm-seed near every full moon, and I have no- 
ticed that no worm cases ever occurred in these families. 
It is usually fried in bacon grease, and then mixed with 
molasses. The dose may be greatly varied, as no harm 
seems to follow its use. When there is acid in the stomach 
or bowels, lime-water, or one of the alkaline carbonates, 
may be usefully associated with the bitters. The rules ap- 
plicable to the treatment of dyspepsia may be considered 
as in force in the present case. Very often, however, after 
the expulsion of the worms, all unpleasant symptoms cease, 
and no further treatment is necessary. 

ROUND-WORM ASCARIS LUMBRICOIDES. 

The round-worm generally inhabits the small intestines, 
but not unfrequently makes its way upward into the sto- 
mach, or downward into the rectum ; and sometimes escapes 
from the alimentary canal by the mouth or by the anus. 
It occasionally enters other passages which communicate 
with that canal, having been found in the posterior nares, 
the trachea, the pancreatic and biliary ducts, and the gall- 
bladder. It is sometimes solitary, but more generally in 
considerable numbers ; and two hundred have been known 
to pass from one patient in the course of a week. The 
worm is supposed to feed upon the intestinal mucus, which 
is usually copious where these parasites exist. It occurs 



790 MISCELLANEOUS DISEASES. 

most frequently in children, occasionally in adults, and sel- 
dom in old persons. Of all the different worms that infest 
the bowels, this is by far the most common. 

The symptoms are those already enumerated as resulting 
from intestinal worms in general. The most characteristic 
signs are perhaps a tumid abdomen, irregularity of the 
bowels, depraved appetite, picking of the nose, and grinding 
of the teeth in sleep. When these worms exist in the sto- 
mach, they occasion peculiar deranged sensations in the 
epigastrium, with nausea, and frequent retching, and motions 
on the part of the patient as if he were choking from some- 
thing in the throat, produced probably by attempts of the 
worm to enter the oesophagus, or by its actual presence in 
that tube. When these motions occur in an infant, the 
round-worm may be suspected to exist in the stomach. 
But the only certain proof that a patient is or has been la- 
boring under this worm, is the sight of it after it has passed 
from the bowels or been discharged from the stomach. It 
sometimes comes away spontaneously from the anus, and 
is not unfrequently evacuated with .the faeces, thus affording 
the requisite evidence of its existence. 

The general course of treatment for worms already de- 
scribed is applicable to this species. A good remedy at the 
commencement, and one which will alone, in a great majority 
of cases, produce an evacuation of the worms, is an infusion 
of senna and pink-root, with sulphate of magnesia to correct 
the griping property of the cathartic, manna to cover the 
taste, and fennel-seed or other aromatic to correct the flavor, 
and to render the whole more acceptable to the stomach. 
This infusion may be given in a small dose once or twice a 
day, so as to produce two or three evacuations in the twenty- 
four hours, and may be continued daily, or every other day, 
for one or two weeks, or even a longer period, if necessary, 
and it do not too much debilitate the patient. Formula : 
Senna and pink-root, each half an ounce ; epsom salts, two 
drachms ; fennel-seed, two drachms ; manna, one ounce ; 
boiling water, one pint : let steep in a covered vessel two 
hours. Dose : for a child two years old, about half an 



INTESTINAL WORMS. 791 

ounce ; for adults, from two to four ounces. A little savine, 
or other vegetable anthelmintic, may sometimes be advan- 
tageously added to the infusion, in obstinate cases. 

If evidences of deranged biliary secretion exist, or the 
bowels bo too irritable for the use of the above infusion, or 
if the infusion has failed, or any difficulty exists in the way 
of its exhibition, calomel may often be advantageously re- 
sorted to. This is, indeed, one of the most efficacious an- 
thelmintics, and has the great advantage, in the cases of 
children, of easy administration. It is best given in con- 
nection with powdered pink-root, and followed, at a proper 
interval, by castor oil. To a child, four grains of calomel 
and sixteen of pink-root may be given at bed-time, and fol- 
lowed by a dose of castor oil in the morning ; and the rem- 
edy may be repeated once and again, if required, at intervals 
of three or four days. In adults, the calomel and pink-root 
may be associated with some quicker cathartic, as jalap, 
scammony, or the compound extract of colocynth. 

Another plan is to administer, morning and evening, for 
several successive days, a dose of some anthelmintic, and 
afterwards a purgative dose of calomel or other cathartic, 
to expel the debilitated or dead worms. For this purpose, 
in the case of a child, half a fluidounce or a fluidounce of 
the officinal infusion of pink-root, or from ten to twenty 
grains of the powder ; from twenty to forty grains of pow- 
dered worm-seed, (chenopodiimi,) or from five to ten drops 
of the volatile oil ; from five to twenty drops of the oil of 
turpentine ; or a drachm of an electuary made by incorpo- 
rating the bristle of cowhage with syrup or molasses, may 
be employed. The oil of turpentine is peculiarly efficacious 
in stomach worms. In our Southern States, where the Pride 
of China grows, the bark of the root of that tree is much em- 
ployed. Four ounces of the fresh bark are boiled with two 
pints of water down to one, and a tablespoonful is given to 
a child for a dose. The cedar apple, an excrescence upon 
the branches of the Juniperus Virginiana, or common red 
cedar, has been highly recommended, in the dose of from 
ten to twenty grains of the powder, repeated as above men- 



792 MISCELLANEOUS DISEASES. 

tioned, and will often prove effectual. The above anthel- 
mintics may be employed successively, one of them some- 
times succeeding when another has failed. 

In nervous cases, advantage may result from combining 
assafoetida, garlic, or valerian, with the more decided anthel- 
mintics. When the digestion is feeble, the vegetable bitters, 
or chalybeate preparations, should be employed in a similar 
connection, and, in case of the existence of an excess of 
acid in the stomach or bowels, antacids should also be 
added. 

THREAD-WORM ASCARIDES. 

The peculiar seat of ascarides is the rectum, but they 
sometimes also inhabit the colon, and are said to have been 
occasionally seen in the stomach. In the female they some- 
times enter the vagina, giving rise to severe irritation and 
intense itching, and even to symptoms of nymphomania. 
They are usually in great numbers, and multiply very rap- 
idly. Persons of all ages are liable to them, but they are 
most frequent in children. 

Their characteristic symptom is an itching sensation at 
the anus, which is often distressing and almost insupport- 
able, especially in the evening, and after the patient has 
become warm in bed. Tenesmus, mucous or bloody dis- 
charges, and small tumors about the anus, are also among 
their effects. These local symptoms are in some cases all 
that are exhibited; but the general derangements which 
have before been described as produced by worms, may 
proceed also from this species. Disorder of the nervous 
system is especially apt to occur, from the intense local irri- 
tation occasioned by the movements of the worms ; and 
this disorder amounts sometimes in children to general con- 
vulsions. 

Treatment. — Medicines taken by the mouth are usually 
less efficacious in this than the other species of worms. 
The most successful plan is to address the remedies imme- 
diately to the rectum, and, having weakened or destroyed 
the worms by anthelmintic enemata, then to procure their 



INTESTINAL WORMS. 793 

expulsion by cathartics taken in the ordinary way, or thrown 
into the bowels. The substances most advantageously em- 
ployed in enemata are oil of turpentine, aloes, common salt, 
decoction of rue or wormwood, infusion of tobacco, sulphur- 
etted waters, and vinegar. Some one of these, or some 
combination of them, should be injected daily, with a suffi- 
cient quantity of water, and, after several days, should be 
followed by a dose of calomel or aloes, or other brisk ca- 
thartic. A dose of sulphur, taken every morning before 
breakfast, has been found very useful. Advantage has also 
been derived from the introduction into the rectum of a 
bougie smeared with mercurial ointment, or of a candle or 
piece of fat pork tied to a string, which, after having been 
allowed to remain for some time, is withdrawn with the 
worms adhering to it. In adults, much relief may some- 
times be obtained by the greased finger employed in like 
manner. Injections of olive oil, or other mild fixed oil, and 
the external application of creosote incorporated with some 
unctuous matter, have been recommended as palliative mea- 
sures. The frequent local use of cold water also allays the 
itching. It is advised to avoid exposure to heat, or the 
use of stimulating articles of food. When the worms have 
found their way into the vagina, injections of cold water 
with vinegar and pink-root tea are recommended. 

LONG THREAD-WORM TRICHOCEPHALUS DISPAR. 

This worm is found most frequently in the csecum or 
other part of the colon, but sometimes also in the small in- 
testines, either loose, or with its anterior capillary portion 
inserted into the mucous membrane. It is often observed, 
in great numbers, in the bodies of individuals who have 
died suddenly, by accident or from some acute disease, and 
who have exhibited no evidences of its existence during 
life. It does not appear that there are any peculiar symp- 
toms which indicate its existence, or that any special course 
of treatment is to be pursued. Should the ordinary signs 
of worms be present, the remedies adapted to the ascaris 
lumbricoides may be employed. 



794 MISCELLANEOUS DISEASES. 

COMMON TAPE-WORM, (TAENIA SOLIUM) BROAD TAPE-WORM, 

(TAENIA LATA.) 

Between these two worms there seems to be no such dif- 
ference in their habits, residence, symptoms, or treatment, 
as to require a distinct practical consideration. The follow- 
ing observations may, therefore, be considered as applicable 
to both kinds. The broad tape-worm is said to be found 
only among the inhabitants of Switzerland, Poland and 
Russia, or in individuals who have been in those regions; 
the taenia, or common tape-worm, is met with everywhere. 

They inhabit chiefly the small intestines, and are often 
solitary, but sometimes also in numbers, though less nume- 
rous than the other intestinal worms. They occur during 
childhood, but more frequently after puberty, and are very 
rare in old age. Females are more subject to them than 
males. They are much more common in some countries 
than in others, and are comparatively rare in the United 
States, at least within the limits of my observation. Per- 
haps this result may be ascribed to the abundance of whole- 
some food within reach of everybody in this country. Tape- 
worms often exist in large and tangled bunches, so as to 
interfere mechanically with the proper performance of the 
intestinal functions. 

Symptoms.- — In some instances the tape-worm has long 
existed in the bowels without producing any very prominent 
symptoms ; but it generally occasions great discomfort, and 
sometimes materially deranges the health. There is not 
often perhaps very acute pain; but the sensations expe- 
rienced are scarcely less distressing than pain, and are often 
attended with great depression of spirits or irritability of 
temper. These sensations are referred to the movements 
of the worm. 

Treatment. — Tape-w r orms have the power of retaining their 
place very tenaciously in the bowels, possibly in consequence 
of holding on to the mucous coat by means of suction. 
They often continue for years to- harass the patient, who 
passes from time to time separated joints, or even a whole 
worm, without getting entirely rid of the troublesome para- 



INTESTINAL WORMS. 795 

site. The duration of the affection, according to the ob- 
servation of Wawruch, varies from a few months to thirty- 
five years. It is considered important that the head of the 
worm should be expelled, as, until this happens, there is no 
certainty that the evil has ceased. Many different plans 
of treatment have been employed with asserted success ; 
most of them including active purgation, and the use of 
substances calculated to injure or destroy the worm. What- 
ever method of cure is followed, much pain is often expe- 
rienced by the patient just before the expulsion of the 
worm, which is ascribed to the violent movements of the 
animal, under the influence of the medicine. It is deemed 
best to prepare the patient by a somewhat restricted diet 
upon the day preceding the use of the medicine, which 
should be given in the morning upon an empty stomach. 
By some it is even advised to precede the anthelmintic, for 
four or five days, by a spare diet, consisting chiefly of 
liquids, and by the use of saline or other laxatives, so as to 
leave the worm with as little protection as possible from the 
alvine contents against the influence of the active purga- 
tives, or the anthelmintics, which may be given for its ex- 
pulsion. The following remedies are those which have 
attracted most notice. 

The medicine at present probably most relied on is the 
oil of turpentine. This is given in large doses, and very 
often with the speediest and happiest effects. The quantity 
administered at once varies from half a fluidounce to two 
fluidounces, and much exceeds the dose of the medicine for 
ordinary purposes. But, in this large dose, the oil is thought 
to be less apt to produce constitutional disturbance or irri- 
tation of the kidneys ; because, acting as a cathartic, it is 
less apt to be absorbed. The only inconveniences usually 
experienced are heat of stomach, some general febrile ex- 
citement, and a sense of fulness in the head ; but sometimes 
it occasions headache, vertigo, a kind of intoxication or 
delirium, drowsiness, etc. ; and these effects will occasionally 
continue for several days. They are most apt to follow 
when the medicine fails to act as a cathartic. The oil usually 
operates quickly upon the bowels, and brings the worm or 



796 MISCELLANEOUS DISEASES. 

portions of it away dead along with it. The caution, how- 
ever, should always be observed, if it do not purge in the 
course of two or three hours, to administer a full dose of 
castor oil, and to aid the action of the medicine, if necessary, 
by enemata. A good plan, in order to insure the cathartic 
action, is to give the two oils conjointly, half a fluidounce 
of the oil of turpentine being mixed with an ounce of castor 
oil, and the dose repeated in a few hours if it should fail to 
operate. 

Perhaps next in value to the oil of turpentine is the bark 
of pomegranate root. Much published testimony exists in 
its favor. The fact that a living tapeworm, introduced into 
a decoction of the bark, immediately evinces great suffering 
by its writhings and contortions, and dies in the course of 
five minutes, while it is capable of living several hours in 
pure water, is a proof that the bark is poisonous to the ani- 
mal. The remedy may be administered in powder or decoc- 
tion ; but the latter form is usually preferred. Two ounces 
of the bruised bark are macerated in a quart of water for 
twenty-four hours, and the mixture then boiled down to a 
pint. A wineglassful is to be given every half-hour, hour, 
or two hours, until the whole is taken, or a powerful action 
is produced. The remedy often produces nausea and vomit- 
ing, and generally purges, and the worm comes away with 
the stools. It is recommended to diet the patient strictly, 
and give a dose of castor oil on the preceding day, and, if 
the decoction- should not purge, to follow it with castor oil 
or an enema. Should the worm not be discharged at the 
first trial, it is recommended to repeat the remedy daily for 
three or four days, or until the desired effect is obtained. 
Various other remedies have been recommended, with which 
I will not trouble the reader. 

PROLAPSUS ANI. 

Of this complaint there are three varieties : in one the 
rectum, together with all its tunics, falls downward ; in 
another, only its internal coat is protruded ; and in the third 
species, an upper portion of the intestine descends into the 
lower one, so as even sometimes to protrude at the anus. 



PROLAPSUS ANI. 797 

The last case is termed a volvulus, or intussuscejrtio. When 
we speak of a prolapsus ani, we commonly mean the first 
kind of disorder. As the intestine descends, it becomes 
turned inside out : hence, the outside of the protruded part 
is in fact the inside of the gut. 

There are two kinds of causes by which the prolapsus is 
produced, viz., such as weaken the sphincter and parts re- 
taining the rectum in its situation, or such as force the 
intestine downward. Those of the first description are only 
predisposing ones ; but the latter causes often occasion a 
prolapsus quite independently of the others. Costiveness 
and hardened faeces, which distend the rectum and sphincter 
ani, and emollient clysters, which relax these parts, are the 
chief predisposing causes. The prolapsus ani is mostly seen 
afflicting children and aged persons ; the first on account of 
the relaxation and elasticity in their systems, the latter on 
account of the want of muscular power in the sphincter ani. 
When the rectum has once descended, a weakness and relax- 
ation are very apt to continue afterwards, occasioning a re- 
currence of the complaint from the slightest causes. Among 
the second class of causes, we have to enumerate long-con- 
tinued inclination to go to stool, kept up by hemorrhoids ; 
ascarides; a fistula in ano ; a stone in the bladder; diarrhoea; 
labor pains, etc. . 

When the prolapsus is recent and inconsiderable, its re- 
duction may frequently be effected by gentle pressure with 
the hand. But when the protruded portion of the gut is 
large, and the prolapsus has existed several hours, the re- 
duction very often cannot be so easily accomplished. Then 
the following plan is to be tried : the patient, having emptied 
his bladder, is to place himself in a position in which he 
rests upon his knees and elbows. The operator is now to 
try to reduce the prolapsus, by making alternate pressure, 
first on one side, then on the other, of that portion of the 
gut which is nearest the opening, until the whole is returned. 
Though the whole may have been reduced within the anus, 
still the gut is ready to protrude again at the first oppor- 
tunity. Hence, the prolapsed piece of intestine must be 
pushed farther upward than just within the anus. 



798 MISCELLANEOUS DISEASES. 

Sometimes the reduction cannot be effected, on account 
of an incessant, involuntary, spasmodic straining. Here 
soft poultices and opiate draughts and clysters are indicated. 
A large quantity of hardened excrement in the large intes- 
tines may render reduction difficult; in this case, the object 
cannot be accomplished until the bowels have been emptied 
by clysters. When the prolapsed portion of the gut is very 
much swollen, its size may be lessened by applying leeches 
or cold lotions to it ; or by making long-continued pressure 
before trying to reduce it. After the prolapsus has been 
reduced, the patient must keep himself for a time in a hori- 
zontal posture, for the intestine is very prone to fall down 
again. Also, to prevent this event, astringent clysters may 
be administered. But, above all things, it is essential to 
keep the bowels free from costiveness. 

When reduction is long delayed, the tumor may become 
painful and inflamed. The same symptoms as attend a 
strangulated hernia, and even death, may follow the pro- 
traction of the case. The immediate cause is the constric- 
tion produced on the bowel by the sphincter ani. The 
proper line of conduct is to employ topical bleeding ; cold 
lotions ; and gentle, long-continued, equal pressure. If 
such measures should fail, and the dangerous symptoms 
increase, it is necessary to divide the sphincter ani, by 
means of a curved bistoury and a director. 

Every prolapsus occasions a remaining weakness and 
relaxation in such parts as retain the bowel in its natural 
position ; and for this reason the complaint, when neglected, 
often becomes habitual. A proper bandage and astringent 
clysters may here be of service. 

The clysters are usually composed of the decoction of 
oak bark, with alum, port wine, etc. 

When these fail, some benefit may be obtained from 
wearing the T bandage, with a piece of sponge applied as a 
compress to the anus. It is to be observed, however, that, 
though bandages keep up the bowel, a volvulus frequently 
follows their employment; and as they are of necessity 
taken off when the patient goes to stool, they present a 
very faint prospect of radically curing even the prolapsus 



volvulus. 799 

ani, as the bowel regularly descends whenever there is a 
motion. The patient should be cautioned to prevent the 
descent of the gut with his finger on this occasion ; but he 
cannot always hinder the event. 

When a prolapsus ani has been neglected, and has not 
been properly kept reduced, the protruded rectum often 
loses all vestige of its natural texture, and becomes indu- 
rated, exceedingly thickened, and, as it were, quite callous 
and insensible. The patient experiences no inconvenience, 
except what results from a large, hard tumor at the anus. 
Hence the disorder is usually left to itself. However, a 
long perseverance in a horizontal posture, frequent long- 
continued pressure, and the constant use of cold washes, 
have been known to diminish the size of such a tumor, so 
as to render its return practicable. If the large callous 
tumor should ulcerate, impede the exit of the faeces, or 
become in any other way exceedingly troublesome, it may 
be amputated. 

VOLVULUS, OR INTUSSUSCEPTIO. 

This is hardly to be distinguished from the prolapsus ani. 
The protruded intestine is not the rectum, but the colon. 
The csecum, and even the ilium, may protrude out of the 
rectum ; then, of course, the nature of the case is clear from 
the structure of these viscera. The parts may be returned 
into the rectum, but the case is incurable ; for who can 
undertake to replace the colon, much less the other intes- 
tines, in their natural position ? 
51 



800 WOUNDS, INJURIES. AND ACCIDENTS. 



WOUNDS, INJURIES, AND ACCIDENTS. 



It cannot be expected that the subjects which might be 
properly considered under this head can be treated of fully, 
as that would include the whole science and practice of 
surgery, and would of itself make a large volume ; only 
such as are of most frequent occurrence, and which can be 
managed without much surgical skill, and cases in which 
something must be done immediately which may save the 
life of the patient until scientific aid can be procured, will 
be considered here. 

WOUNDS. 

Wounds are different according to the kind of force by 
which they are made. When done by cutting with a sharp 
instrument, they are said to be incised ; when by tearing, 
lacerated ; and when by bruising, they are called contused 
wounds. 

Our first attention is usually drawn to the bleeding or 
hemorrhage which attends injuries involving a division of 
blood-vessels of considerable size. This will usually be 
most profuse in incised wounds ; for in those made by 
tearing or bruising, the divided ends of the vessels are 
always more or less closed, and the fibrin of the blood, by 
becoming entangled by the shreds of the rough extremity 
of the vessels, soon collects so as to form a clot, and impede 
or prevent the escape of the blood. In incised wounds, we 
must endeavor to bring about the same thing artificially : 
this may be done by bringing the divided surface firmly 
together ; and confining it by compresses and bandages ; or 



WOUNDS. 801 

by thrusting cloths into the wound, so as to form a plug. 
Many a wounded soldier has thus arrested the bleeding 
from extensive wounds by cramming his handkerchief into 
the wound, so as to plug the mouths of the bleeding vessels, 
which gave time for the use of other means. But if the 
wound has been made by a sharp instrument, and the 
divided vessel be an artery of considerable size, these 
measures will probably not prove sufficient to stay the 
hemorrhage, and compression of the artery between the 
wound and the heart must be made. This may be done in 
a limb by a ligature drawn tightly above the wound. If 
the position of the main artery can be ascertained, which is 
commonly easily done by feeling its pulsations, a compress, 
made by rolling up a piece of cloth or paper firmly, and 
placing it over the artery, and then tightening the bandage 
or ligature, will close the artery and stay the bleeding. 
Sometimes the bleeding can be stopped by firmly grasping 
the limb with the hand, if no assistance is at hand, or until 
a bandage and compress can be arranged. Even the great 
femoral artery has been controlled by firm pressure made 
with the thumb on it, at the point where it passes over the 
bone at the groin. 

Very little skill is required for the management of 
incised wounds. After removing any dirt or foreign body 
from the wound, its edges should be brought accurately 
together and confined by means of adhesive strips, or a 
compress and bandage, or by all of these, so that the 
minute vessels may reunite by what is called union by the 
first intention. And even if the parts are not in exact con- 
tact, plastic lymph will soon be thrown out sufficient to fill 
the space, and the vessels will extend through this until 
they meet and form a reunion. 

Nothing more is usually necessary to be done, except 
that it is well to keep the dressing wet with cold or tepid 
water; but if there is considerable suffering, laudanum or 
chloroform liniment, or even whiskey, may be combined 
with the water. 

Now if the divided surfaces are not properly adjusted, 
and brought very nearly in contact, a reunion cannot take 



802 WOUNDS, INJURIES, AND ACCIDENTS. 

place without the processes of suppuration and granulation* 
and of course the cure will be much slower. But nothing 
more is usually necessary, even in this case, than to keep 
down febrile excitement by cold lotions or poultices ; or to 
stimulate the parts with strong spirits or chloroform lini- 
ment, if the action appears to be too low. 

Recollect that pus is the bland, cream-like secretion which 
is always thrown out by a healthy granulating surface, and 
that it constitutes the mildest dressing which can be applied 
to the delicate and often sensitive surface, and therefore it 
is wrong to remove it, except that any superabundance may 
be gently washed away by squeezing a cloth saturated with 
tepid water, and holding it in such a position that the 
water will dribble over the sore. But it is often almost 
impossible to convince nurses that there is nothing poison- 
ous or irritating in pus or matter, and they will pertina- 
ciously persevere in removing it at each dressing, much to 
the discomfort of the patient ; for the sore will usually con- 
tinue to complain after the removal of the pus until a fresh 
secretion again covers the surface. Now in sores of a 
small extent the injury resulting from this practice is not 
great, but in case of large granulating surfaces, as from 
extensive burns or scalds, the irritation consequent upon 
forcibly removing the pus is often sufficient to produce 
great nervous disturbance, and seriously interfere with the 
recovery. 

If the wound has been made by a tearing process, it is 
not so likely to heal by a reunion of the vessels, or through 
the medium of plastic lymph, but yet it often does, and 
therefore the edges should always be carefully adjusted and 
held in place by adhesive plasters, etc., and if the whole 
surface should fail to unite, a part probably will, and thus 
lessen the amount which will require to be repaired by 
granulation. 

But if the injury has been made by a blunt or round 
body, the tissues will be more or less bruised, and this may 
be sufficient to cause a death of the part, or it may only 
weaken the tissues so as to cause the capillaries to give 
way to the pressure of the blood, and become engorged or 



FRACTURES AND DISLOCATIONS. 803 

congested, and these two conditions may exist at the same 
time ; in fact, when the force has been sufficient to destroy 
the life of a part of the tissues, another part beneath this, 
or outside of it, will always be found in the second condi- 
tion. The prominent idea to be had in view, therefore, in 
the treatment of contused wounds, is to restore vital action 
in the weakened vessels and other tissues implicated ; 
stimulants are therefore indicated, and no stimulant will be 
found to answer the purpose better than the chloroform 
liniment; for, while it excites the capillaries and other 
parts into vigorous life, it soothes the injured nerves, and 
thus relieves the suffering. But in the absence of the 
liniment, a pretty good substitute may be found in the 
common domestic remedy of brown sugar and spirits of 
camphor. But if the injury be serious, the liniment should 
be procured, as its application will cause a speedy separa- 
tion to take place between the dead and the living tissues, 
and will also prevent any unpleasant odor from arising 
from the decomposition of the dead parts, and will secure 
healthy suppuration and granulation, and a rapid repro- 
duction of the lost tissues. 

Gun-shot wounds require no peculiar treatment, except 
that foreign bodies are often imbedded in the wound, 
which must be^ carefully removed, or they will keep up 
irritation and prevent a cure ; unless, as is sometimes the 
case, a plastic material should become organized around the 
body, and form an insensible coat for it, in which case it 
may remain during the remainder of life without causing 
annoyance. 

As the momentum of the ball is generally sufficient to 
kill a layer of tissue around the opening made by its 
passage, union without suppuration and granulation will 
rarely take place. The process of softening and casting off 
the dead tissue may be much hastened by daily injections 
of castile soapsuds, and then followed with chloroform lini- 
ment weakened with whiskey. 

FRACTURES AND DISLOCATIONS. 

As this work is not intended to supersede the necessity 



804 WOUNDS, INJURIES, AND ACCIDENTS. 

of the services of the scientific surgeon, which indeed can 
never be done, nothing more will be necessary to be 
offered upon the above subject than a few plain directions 
which may be followed in the absence of professional skill. 

FRACTURES. 

Fractures are of two principal kinds, viz., simple and 
compound. 

By a simple fracture is implied a division of one or more 
bones, without any external wound, caused by the protru- 
sion of the ends of the fractured bones. It is called com- 
pound fracture when there is a laceration of the integuments, 
caused by the protrusion of one or both the ends of the 
fracture. 

To these divisions of the subject some add a third, 
calling that fracture complicated which is attended with 
several breaches of continuity in the injured bone, and with 
the wound of any large nerve, blood-vessel, etc. 

Fractures are also distinguished into longitudinal, trans- 
verse, and oblique, according to the direction in which 
they run. 

SIMPLE FRACTURES. 

The symptoms of fractures are exceedingly various, 
according to the bones which are broken ; and though 
almost all writers have indiscriminately mentioned loss of 
motion in the injured limb, deformity, swelling, tension, 
pain, etc., as forming the general diagnosis of fractures, yet 
it is easily comprehensible, by any one acquainted with the 
structure of the body, that numerous fractures cannot pre- 
vent the motion of the part or occasion outward deformity ; 
and though at first there may be pain in the situation of a 
fracture, no swelling and tension take place till after a 
certain period. 

When therefore a limb is broken,' and the event is not 
manifest from the distortion of the part, it is proper to trace 
with the fingers the outlines of the suspected bone, and 
wherever any unusual pain occurs, or any unnatural irregu- 
larity appears, to try if no grating or crepitus can be felt on 



SIMPLE FRACTURES. 805 

endeavoring to make one end of the bone rub against the 
other. When the arm or thigh bone is the subject of 
injury, a crepitus is felt almost as soon as the limb is 
touched, and in the case of the thigh there is considerable 
shortening of the extremity, unless the fracture be of the 
transverse kind. But when there are two bones, as in the 
leg and fore-arm, and only one is broken, the other con- 
tinues to prevent the limb from being shortened and thrown 
out of its natural shape, so that a crepitus can only be felt 
by a proper examination with the fingers. I am aware that 
considerable harm and great unnecessary pain have been 
occasioned by an over-officious care to feel the grating of 
fractured bones, and, whenever the case is sufficiently 
evident to the eye, all further examinations may well be 
dispensed with. A fracture is an injury that is necessarily 
attended with considerable pain, and followed by a great 
deal of tension, and to increase these evils by rough 
handling of the part is above all things cruel and un- 
called for. 

In cases of fractures, the muscles of the limb are often 
affected with involuntary spasms, which put the patient to 
great pain, and, when the thigh-bone, arm-bone, or both 
bones of the leg or fore-arm are broken, occasion great dis- 
tortion, while the violence of each spasm continues. To 
counteract this, and also to relieve the pain, a full dose of 
opium should be given, and a stream of tepid water poured 
for some time upon the limb. 

Process by which Fractures are united. — The steps of 
nature in the union of broken bones are very similar to 
those which she pursues in the union of wounds of the soft 
parts. The vessels ramifying on the ends of the fracture 
first effuse coagulating lymph. This gradually becomes 
vascular ; and as its vessels acquire the power of depositing 
earthy matter, it is ultimately converted into new bone, 
termed callus, which becomes the bond of union between 
the two portions of the fractured bone. 

In order that the first connecting substance may speedily 
become organized and fitted for the formation of callus, 
nothing is so favorable as perfect quietude. Hence the 



806 WOUNDS, INJURIES, AND ACCIDENTS. 

chief indication in the treatment of fractures, after the endb 
of the bones are replaced, is to keep them perfectly motion- 
less : nature completes the rest. Different bones require 
different lengths of time to become firmly united ; the ribs 
and clavicle unite as soon as any; the arm-bone is com- 
monly tolerably firm in five weeks ; but the bones of the 
leg and the os femoris seldom become perfectly strong in 
less than six weeks. These calculations refer, however, to 
adults; for in children fractures are cured much more 
quickly than in grown-up persons. The more vascular the 
bones are, the sooner is the union of their fractures accom- 
plished. 

General Principles in the Treatment of Fractures. — Relax- 
ation of such muscles as have the power to displace the 
ends of a fractured bone extremely facilitates the reduction. 
A proper position is, indeed, the first thing to be attended 
to in almost all cases in which the broken extremities of 
the bone are not in even contact. The muscles are the 
powers which cause the displaced condition of the fracture, 
by drawing that end of the bone which is most movable 
out of its proper position in regard to that which is most 
fixed. Hence, in the extremities, the lower ends of frac- 
tures are those which are truly displaced by being drawn 
upward or to one side by the action of certain muscles, 
which have their origin and insertions above and below the 
injury. The muscles, therefore, which have the power of 
displacing the lower ends of such fractures are the powers 
which we ought principally to endeavor to counteract. In 
oblique fractures it is much more difficult to keep the ends 
of the bones in a proper state of apposition, because two 
oblique surfaces make no mechanical resistance to that 
effect (viz., retraction of the lower portion of the broken 
bone) which the strong muscles have a continual tendency 
to produce. 

But relaxation of the muscles which have the greatest 
influence over a fracture is not only to be observed during the 
time of setting the broken bone ; it is to be strictly adopted 
throughout the whole cure, at least until the two ends of 
the bone have become firmly united together. Were this 



COMPOUND FRACTURES.- 807 

plan not followed, the fracture would very soon be displaced 
again by muscular action. 

The best means for obtaining relaxation are, Dover's 
powder, a straight position of the limb, moderately tight 
bandaging, and effusions of tepid water. 

But, much as position facilitates the favorable union of 
fractures, other means are necessary for maintaining the 
ends of the broken bone in their proper situation, and in a 
perfectly quiet state. Mechanical contrivances are employed 
to give that degree of support to the limb which the breach 
of continuity in the bone or bones has taken away. Instru- 
ments called splints are applied for this purpose, so as to 
form as it were a kind of steady, unyielding case for the 
limb. Splints ought to be made of strong materials, and of 
a sufficient length to reach beyond the two joints nearest 
the fracture ; and they ought to be adapted in shape to the 
contour of the limb. They are generally secured by straps 
or tapes. 

Since splints, however, are hard, and would give pain if 
firmly applied to the limb without the intervention of soft 
materials, it is customary to place a soft compress immedi- 
ately over the fracture, and to apply what is termed an 
eighteen-tailed bandage, between which and the splints are 
also interposed pads filled with tow, or any other soft sub- 
stances. Compresses are generally placed in situations under 
the splints where the pressure from such hard instruments 
is likely to give most pain. 

When there is much swelling before the fracture is set, 
surgeons generally apply cold lotions of sugar of lead ; and 
the linen employed for this purpose can be kept sufficiently 
wet (without taking off the splints) by squeezing the lotion 
out of a sponge into the interspaces between them. But I 
greatly prefer whiskey and water to the lead lotions. 

COMPOUND FRACTURES. 

A compound fracture is accompanied with a wound of 
the integuments, caused by a protrusion of the end of the 
broken bone. 

When the wound is large and lacerated, when the bone or 



808 WOUNDS, INJURIES, AND ACCIDENTS. 

bones are splintered into several pieces, and when the neigh 
boring muscles have suffered a violent degree of contusion, 
tHe case must be considered as extremely dangerous, and 
the brightest talents are required to guide its treatment. 

A limb in this condition, submitted to the inspection and 
judgment of the discerning and scientific practitioner, pre- 
sents to him one of the most difficult cases, requiring a 
sudden decision, that is met with in surgery. Under these 
circumstances, no time should be lost, but the best surgical 
skill obtained as soon as possible ; for a short time often 
determines the event of the case in a fatal manner. But 
if none can be obtained, the best you can do is to adjust 
the limb and draw the divided surfaces together; apply 
chloroform liniment and whiskey to allay pain and produce 
reaction ; give an opiate ; keep the patient quiet, etc. 

If the patient is much prostrated, brandy may be freely 
given. When reaction is fairly set up, tepid effusions may 
be necessary for subduing inflammatory action in the injured 
part. 

When the wound suppurates, it must have such dressings 
as circumstances require, taking care that at each application 
of them, the fracture is disturbed as little as possible. 

DISLOCATIONS. 

When the articular surfaces of bones are thrown out of 
their particular places, the accident is termed a dislocation, 
or luxation. 

Dislocations are divided, like fractures, into two principal 
kinds, viz., simple and compound : simple, when there is no 
external wound communicating with the cavity of the dis- 
located joint; compound, when the injury is attended with 
a wound of this description. Luxations have also been 
distinguished into ancient and recent; complete and incom- 
plete. 

The diagnostic marks of dislocations chiefly consist of 
circumstances arising from the functions of the affected 
joint being interrupted, and the lodgment of the articular 
extremity of a bone in an unnatural position, and among 
parts which it compresses and renders painful. Hence, there 



DISLOCATIONS. 809 

is a loss of motion in the joint ; the limb or part is either 
shortened, lengthened, or distorted to one side, according to 
the kind of dislocation ; the pressure of the dislocated head 
of the bone on the surrounding parts causes considerable 
pain, which is immensely increased when the limb is moved. 
The head of the dislocated bone may sometimes be distinctly 
felt, forming a preternatural tumor or projection, while in the 
situation of the articular cavity there is an unusual depres- 
sion, or want of fulness in appearance. 

Luxations are produced by external violence, which rup- 
tures such ligaments as naturally restrain the dislocated 
heads of the bones from being thrown into the particular 
directions in which, in various cases, they are found situated. 
Even tendons, proceeding over the surface of the joints, are 
frequently lacerated. 

The degree of danger in cases of luxations is very much 
altered by the circumstance of the case being a simple or a 
compound one. Simple dislocations, when recent, may com- 
monly be reduced with facility, and they cannot be reckoned 
at all dangerous cases. Compound dislocations of large 
joints, on the other hand, are, like compound fractures, fre- 
quently attended with danger; and the same nicety of judg- 
ment is requisite in determining whether amputation ought 
to be immediately performed, or an effort made to preserve 
the limb, as in cases of compound fractures. 

The indications in the treatment of dislocations are to 
reduce the displaced articular surface as speedily as possible, 
and to support the joint with bandages or splints, until the 
lacerated ligaments, tendons, etc., have had an opportunity 
of uniting. 

In cases of compound dislocations, it is a most important 
point to obtain a prompt union of the wounc^ as the injury 
can afterwards only be regarded as one of a simple kind. 
The lips of the wound are therefore to be brought accurately 
together with sticking-plaster, and the joint kept perfectly 
quiet in splints. 

In order to reduce dislocations without difficulty, it is 
necessary to consider what muscles have the power of op- 
posing your attempt to bring the dislocated head of the bone 



810 WOUNDS, INJURIES, AND ACCIDENTS. 

into its proper place, and these should be relaxed at the 
time when the extension is made. 

Dislocations, when reduced, are in general not so trouble- 
some to keep right as fractures, and are not so easily dis- 
placed by the actions of muscles. 

Pouring a stream of warm water for a long time upon 
a dislocated joint, and on the muscles which resist its re- 
duction, will cause such a complete insensibility of the parts, 
and so much relaxation, that the joint can generally be put 
in place with very little trouble, and with very trifling pain 
to the patient. I once continued to pour the water for three 
hours, and then put a shoulder-joint into place, without as- 
sistance, that had been out several days, and had resisted 
the force of several strong men. 

As to the manner of reducing different dislocations, the 
operator must exercise his own common sense, which will be 
more likely to direct him right than any partial directions 
which could be given, or even a fuli treatise, which would 
hardly ever be read with the attention necessary to make 
it practical or available when the information would be 
needed. 

OF POISONED WOUNDS. 

The most common wounds of this description are the 
stings of gnats, wasps, bees, and hornets. The bites of 
mad animals and of poisonous reptiles are the most serious. 

It is highly probable that the poison insinuated into 
wounds does not always derange the whole system, merely 
in consequence of absorption. The constitutional symptoms 
would seem sometimes to happen per consensum, before the 
local poison has had time to find its way into the circula- 
tion, as in the bite of the cobra de capello of the East In- 
dies, and the American rattlesnake. 

Hence, in the treatment of all severe poisoned wounds, 
two chief indications arise : 1, to prevent absorption of the 
poison and its alarming effects, either by quickly cleansing 
the wound from it, or by rendering its qualities inert ; 2, to 
appease the sympathetic disorder of the constitution by 
medicines of the sedative and antispasmodic kind. 



BITE OF KEPTILES. 811 

Various are the means that have been used to fulfil the 
first object. Scarifying and cupping the wound, suction, 
the actual cautery, setting fire to gunpowder placed in the 
part, different kinds of oil, powdered cantharides, and exci- 
sion of the injured part, are the principal ones. 

The second indication demands the internal exhibition of 
opium, the volatile alkali, camphor, musk, and similar reme- 
dies. 

STINGS OF INSECTS. 

Bees, wasps, hornets, and other insects of this country, 
produce, in consequence of their sting, a great deal of pain, 
redness, heat, and swelling in the part affected ; but the. in- 
jury never gives rise to any alarming symptoms. There is 
an extraordinary irritability in the skin of many persons, 
who invariably suffer more than the generality of mankind 
from the bites and stings of insects. 

It is certain that the sting of an insect is not simply a 
fine puncture ; for, if it were, there could be no cause for 
such great local uneasiness as it usually creates. The sting 
of the honey-bee is always left behind in the wound, and 
excites irritation. 

Lemon juice, vinegar, Goulard's lotion, cold water, oil, 
and hartshorn, are the principal local applications recom- 
mended in these cases. But the juice of the red onion is 
preferable to any other application I have ever seen made, 
except the chloroform Hniment. Both of these give almost 
instant relief, so that no redness or swelling follows, if ap- 
plied soon. 

BITE OF REPTILES. 

The poison of snakes is lodged in a capsule, situated at 
the root of two fangs in the upper jaw, and is pressed out 
when the animal bites. 

The bite, is not invariably followed by the train of severe 
symptoms we are about to enumerate. This may depend 
on various circumstances ; the animal, just before biting the 
patient, may have bitten something else, so as to have 
emptied the poison-bags completely. The bite may have 



812 



WOUNDS, INJURIES, AND ACCIDENTS. 



taken place through clothes, and great part of the poison 
may have lodged on them. 

Though the poison may be lodged in the wound, there 
may be a tardiness of absorption, and the virus may there- 
fore be washed off by suppuration, without having affected 
the constitution ; or the means made use of may have re- 
moved it completely from the wound. The narrowness of 
the injury is, however, very unfavorable to any attempt of 
this kind. 

The bad symptoms from the bite of the less poisonous 
snakes, as the viper and highland moccasin, or copper-head, 
usually commence in about twelve or fifteen hours. An 
acute pain and a burning heat are experienced in the part 
affected, which begins to swell. The tumefaction, tension, 
heat, and pain, gradually spread over the whole limb, and, 
in some cases, the whole body is said to be swollen. De- 
jection of spirits, smallness and weakness of the pulse, 
headache, nausea, and vomiting, ensue. A fixed pain is 
felt in the region of the heart, and all the surface of the 
body assumes a yellow tinge. The urine seems as if it 
were impregnated with bile. Cold perspirations and con- 
vulsions take place, and death sometimes finishes the 
tragedy. 

The bite of these serpents seldom proves fatal in this 
country. It might, however, kill a child, though it does 
not generally destroy an adult ; for it appears that the dan- 
ger is in proportion to the smallness of the animal bitten. 
The bite of a rattlesnake is much more fatal in its effects 
than that of any other reptile in this country. It often 
kills so speedily that little time is allowed for the use of 
remedies. 

Treatment. — The treatment is divided into the local and 
constitutional means. By the former we endeavor to pre- 
vent the ill effects of absorption ; by the latter we strive to 
appease the derangement of the system, arising either from 
absorption of the poison, or per consensum. 

Treatment applied to the ivound. — Excision of the injured 
part, as soon as possible after the occurrence of the acci- 
dent, is, beyond a doubt, the most efficacious and advisable 



BITE OF REPTILES. 813 

plan. All the other means designed to extract the poison 
completely from the wound, or to destroy its pernicious 
nature, as uncertain in their agency, ought always to yield 
the preference to excision of the part. 

Oil, when applied, must act either by its insinuating itself 
between the poison and the wounded surface, or by becom- 
ing blended with the virus, and rendering it inert. Powder 
of cantharides produces a copious discharge of matter, by 
which the poison is probably washed out of the wound. 
The actual and potential cauteries must act in the same way 
as excision, by killing the part, and allowing the poison to 
be taken away when the slough separates. Perhaps, indeed, 
they may decompose the poison ; but they are not deemed 
of such certain efficacy as the immediate removal of the 
wounded part by the knife. Yet they are certainly prefer- 
able to every means except excision. 

Great care should be taken in excision to go deeper than 
the bite. 

Constitutional treatment. — Two remedies are now princi- 
pally relied on, viz. : spirits, and olive oil. We can com- 
prehend how spirits, given to the extent of full intoxication, 
may act beneficially, by preoccupying the nervous sensibili- 
ties, or by destroying their sensibility for the time, so that 
no impression can be made by the virus. And it is possible 
that the alcohol may, by combining with the poison, so 
change its nature as to render it inert and harmless ; and 
the latter mode is the only conceivable way in which olive 
oil can act beneficially. But that it is a valuable remedy, 
or antidote, for animal poisons cannot be doubted, as much 
recent evidence has accumulated of its efficacy, which can- 
not be controverted. As soon, therefore, as possible after 
a bite has been received from a poisonous reptile, let the 
part be cut out, or strong suction be made with the mouth, 
or by cupping instruments ; then wash the part well with 
whiskey or water, and apply lint or carded cotton saturated 
with olive oil. From two to four ounces of the oil should 
also be taken internally; and, if symptoms of poisoning 
come on, as much good whiskey should be given as will 
make the patient drunk. Care, however, should be observed 



814 WOUNDS, INJURIES, AND ACCIDENTS. 

in the use of this remedy, as children and females, or other 
persons not accustomed to the use of alcoholic stimulants, 
may be killed by an over-dose. It is best, therefore, to 
commence, in such cases, with a moderate dram, and repeat 
it at short intervals, until the full effect of intoxication is 
obtained. 

Ammonia and oil of sassafras both possess great power 
over animal poisons, and have been principally relied on by 
the author for neutralizing them, or counteracting their 
effects. They are usually given in conjunction, as in the 
following formula : Aqua ammonia and oil of sassafras, each 
one drachm, or a teaspoonful ; sweet oil, one ounce ; to be 
shaken well and taken at once. The same may also be 
applied to the wound. 

The oil of sassafras applied to the bites or stings of 
insects will in a very few minutes relieve the itching or 
other suffering occasioned by them. 

SCALDS AND BURNS. 

A moderate degree of caloric, or the matter of heat, is a 
healthy stimulant to the human system, is pleasant to the 
nerves, and excites the capillaries to vigorous action ; but 
applied in excess, it impresses the nerves painfully, and 
excites over-action in the capillaries, so that the exhalants 
throw out the serum of the blood too rapidly for it to pass 
through the pores in the scarf-skin, which seem to be closed 
by the action of the caloric ; and the consequence is, that an 
accumulation of water takes place under it, and violently 
separates it from the true skin, causing much suffering 
in the fine nervous expansion on its surface, and presenting 
the phenomena which we call blisters. Any other stimu- 
lant applied in sufficient force will produce this effect ; as 
Spanish flies, spirits of hartshorn, slapping with flat instru- 
ments, etc. Now if nothing acrid or poisonous has entered, 
so as to continue the irritation, this profuse secretion soon 
relieves the morbid excitement, and the suffering is at an 
end ; and if let alone, the absorbents* will remove the effused 
fluid, by which time a new scarf-skin is formed, and the 
old layer peels off. If the collection of water be moderate, 



SCALDS AND BURNS. 815 

it is best to leave its removal to the care of the absorbents, 
as it serves as the mildest dressing which can be made for 
protecting the exposed nerves ; but if it be large, it is best 
to make minute punctures and let part of it escape, or the 
pressure will not only irritate the nerves, but, if the action 
be low, may cause destruction of the true skin. 

Now as blisters from mere over-stimulation, as from 
ammonia and chloroform liniment, very soon cease to smart 
or give pain, while those from Spanish flies and excessive 
heat do for a considerable time, and often cause active 
inflammation to be set up in the true skin and subjacent 
cellular tissue, it is evident that in these cases something 
has entered the system which for a time prolongs the irrita- 
tion. This is known to be the case in the action of Spanish 
flies ; it is equally certain that it is also the case in blister- 
ing with excessive heat; the caloric becomes positively 
fixed in the tissues, and hence the common idea of a neces- 
sity for something to " draw out the fire " is founded in 
good philosophy. Cold will very quickly remove the free 
caloric and prevent any further injury, but it will not 
remove that which has become fixed or latent in the tissues ; 
hence, though a very suitable remedy when applied quickly 
after the application of the heat, yet at a later period it 
becomes positively injurious ; as by its depressing influence 
it prevents the vigorous vital action which is "necessary for 
throwing off the offending cause. H'ence, if the injury be 
severe, the tissues may die under its influence, producing 
gangrene and mortification, and extensive sloughing if the 
patient lives. And then, if the cold be continued, although 
it allays the suffering, yet when it is withdrawn there will 
often be the same amount of suffering to be gone through 
with as would have been had it never been applied. 

I once saw this strikingly illustrated. A man fell with 
both arms into boiling brine ; cold was immediately applied, 
and continued for a number of days by frequent changes of 
cold slippery-elm poultices ; at length it was discovered 
that the flesh was turning black, and I was sent for. A 
sassafras poaltice was substituted, on which spirits of 
ammonia was freely sprinkled; and as the general action 
52 



816 



WOUNDS, INJURIES, AND ACCIDENTS. 



was low, there being a feeble pulse and cold surface, brandy 
and ammonia were freely given internally. In a few hours 
reaction took place, and the same burning sensation expe- 
rienced in the arms as had been immediately after the 
accident; and this continued for a number of hours. Now 
this suffering was not the effect of inflammatory action, for 
none had taken place — the action being barely sufficient to 
restore a natural temperature and arrest the gangrene ; then 
the sensation was peculiar, being that produced by the 
action of caloric and nothing else. This man recovered, 
but with a loss of much of the soft parts, which took some 
weeks for their reproduction. 

The proper plan of procedure, therefore, is, when a burn 
or scald has been received, to immediately apply cold, and 
continue it until the suffering ceases ; it has now done all 
that it can do beneficially — it has removed the free caloric, 
and prevented any further mischief from this source ; and 
if the fire has not had time to penetrate and become fixed 
in the tissues, and has not been intense enough to act as a 
cautery and destroy the life of the part, nothing more will 
be necessary to be done, as there is in fact nothing more to 
do, as the disease has been aborted. 

But if on removing the cold the burning sensation should 
return, it is folly, it is madness to continue it, as it will at 
best only give momentary ease at the expense of future 
suffering, and may occasion extensive loss of substance, or 
even a fatal collapse. I once saw the latter event brought 
about. A young lady's garments took fire and burnt her 
extensively, but not deeply; cold was applied, and con- 
tinued. Six hours subsequently I saw her ; she was not 
suffering, but her pulse was feeble and fluttering : internal 
and external stimulation were resorted to, but no reaction 
ensued, and she died comatose in a few hours after. Cold 
is best applied by immersing the part in cold spring or ice- 
water, or by covering it with cloths saturated with the 
water, and then pouring water on them from time to time. 
This should never, however, be continued longer than 
half an hour, when, if the burning sensation returns, stimu- 
lants should be applied — those possessing also anodyne pro- 



SCALDS AND BURNS. 817 

perties are to be preferred, so that the nerves may be 
soothed while the capillaries are stimulated; the best I 
have tried is the chloroform liniment, combined with an 
equal portion of oil — castor oil is best; sweet oil, or flax- 
seed oil, or even melted lard, will answer. If the liniment 
is not at hand, use equal parts of spirits of turpentine, 
laudanum, and oil, or whiskey and camphor and oil. A 
soft cloth should be saturated with one of these and applied 
smoothly to the surface, and suffered to remain ; keeping it 
moist by repeated applications to the outer surface. But if 
none of the above means are at hand, cover the surface 
with wheat or rye flour, and should it become saturated 
with the serum from broken blisters, peel it off, and make a 
fresh application. The flour should be applied liberally, so 
as to absorb the serum, and form a protection against the 
action of the atmosphere. If the burn or scald is of no 
great extent, an application of collodion will answer every 
purpose, being stimulant and anodyne, and at the same time 
forming an artificial covering. But if the injury be exten- 
sive, although ever so slight, internal means should also be 
used, and these should possess the indispensable properties 
of being anodyne and stimulant. The fever syrup is pecu- 
liarly appropriate ; next to this, paregoric, or brandy and 
laudanum, will be best. If the heat has not destroyed the 
life of the true skin, the cuticle will be renewed in a very 
short time, and the patient cured ; but should the skin be 
destroyed, as its reproduction is always a slow process, the 
recovery wiU be tedious. Suppuration is commonly pro- 
fuse, and, if the surface be large, may exhaust the patient ; 
it should therefore be moderated by an application of equal 
parts of beefs-foot oil and lime water. Mild dressings, 
such as simple cerate, or castor oil, should alone be used ; 
except the process of healing should appear to flag, and the 
granulations look weak or of too dark a color ; in this case 
the chloroform liniment, weakened with two or three times 
the quantity of whiskey, should be used until the granula- 
tions become firm and of a brighter red color. Should the 
burn be deep, the chloroform liniment will be found to be 
the best application for keeping down any unpleasant odor, 



818 WOUNDS, INJURIES, AND ACCIDENTS. 

and for hastening a separation of the dead parts from the 
living. The parts should also be kept covered with a 
poultice made of equal parts of pulverized sassafras and 
slippery-elm barks. 

The health of the patient should be kept as perfect as 
possible during the cure of bad cases, by attending to the 
condition of the bowels, diet, etc. ; the diet should be light 
and nourishing. 

EFFECTS OF COLD. 

A frozen limb, in which there is no injury of any organic 
part, no other alteration but rigidity of the solids and con- 
gelation of the fluids, may be recovered by the gradual 
communication of caloric to it. Experience has evinced 
that the whole body may be in the same condition, having 
all its vital functions suspended, and yet be restored to ani- 
mation. In this case, however, the gradual impartment of 
heat will not avail, unless the heart and large blood-vessels 
retain the power of action. But since animation, suspended 
in consequence of cold, has been restored after a considera- 
ble lapse of time, neither hope nor exertion should be aban- 
doned. 

When the whole body, or any part of it, is frozen, warmth 
should be communicated to it very gradually. If a limb 
that is not actually frozen, but excessively cold, be suddenly 
heated, very violent inflammation is the result. The part 
swells and becomes red and blue, with insupportable darting 
pains. When a part actually frozen is thus quickly warmed, 
the same symptoms arise, but in an aggravated degree, and 
they soon terminate in mortification. 

In order to thaw a frozen limb, it is best to rub it with 
snow until sensibility and motion return. If the ear or tip 
of the nose should be the part concerned, care must be taken 
to avoid breaking it. If snow be not at hand, ice in water 
should be used instead of it. As soon as marks of sense 
and motion are discerned, the frictions are to be made with 
brandy, tincture of myrrh, camphorated spirit of wine, or 
other stimulants. 

The next object is to endeavor to excite a perspiration by 

/ 



CHILBLAINS. 819 

giving warm teas or mulled wine, and putting the patient to 
bed in a chamber where there is a fire. In this situation he 
is to remain until he begins to perspire, which is generally 
succeeded by a perfect recovery of whatever sensibility may 
have been lost. 

When a part is almost in the state of gangrene, in conse- 
quence of improper exposure to sudden heat, sometimes its 
recovery may still be accomplished by immersing it in water 
of a temperature nearly as low as the freezing point. The 
part must be kept immersed until the swelling, pain, and 
marks of discoloration begin to diminish, when frictions with 
brandy, etc., may commence, and the warmth be gradually 
increased. 

This plan often succeeds when expectation, a priori, can- 
not be very strong. If mortification cannot be avoided, the 
future treatment does not differ from what has been ex- 
plained in the chapter on that subject. In this case, how- 
ever, opium is preeminently useful. 

The treatment of the whole body, deprived of animation 
by cold, is similar to that of a part. It is to be covered 
with snow, or placed in ice-cold water, so that the mouth 
and nostrils are not obstructed, and care is to be taken not 
to break any part. In this way signs of vitality must be 
awaited. When these appear, strong volatiles and sternu- 
tatories are to be applied to the nostrils, and air is to be 
blown into the lungs. 

When the body has been thawed, and signs of returning 
animation increase, it is to be taken out of the water, rubbed 
with brandy, and conveyed into a warmer situation. Any 
diaphoretic drink should then be administered, and as soon 
as the patient has been well dried, he is to be put to bed, 
and remain there till he begins to sweat. 

CHILBLAINS. 

A chilblain in the mild state is a moderately red tumor, 
occasioning heat and itching. The complaint after a time 
spontaneously disappears. 

In a more severe state, the tumor is larger, redder, and 
sometimes of a dark blue color. The heat, itching, and 



820 WOUNDS, INJURIES, AND ACCIDENTS. 

pain are so vehement that the patient cannot use the pari 
affected. 

In the third degree, small vesicles arise on the tumor. 
These burst, leaving excoriations, which soon change into 
sores. The ulcers secrete a thin matter, penetrate deeply, 
and are very slow in healing. 

In the worst cases of chilblains, the inflammation ends in 
mortification, which is often preceded by the formation of 
bloody vesicles on the tumor. 

Causes. — The sudden warming of a cold part, and the 
sudden cooling of a heated part, seem particularly conducive 
to chilblains ; hence, parts most exposed to the vicissitudes 
of heat and cold are most subject to the complaint ; as, for 
instance, the toes, fingers, nose, ears, and lips. 

Treatment. — One of the best applications to chilblains of 
the first and second sort is ice-cold water. The part affected 
is to be immersed in it a few minutes two or three times a 
day, until the complaint quite disappears. This event 
usually happens in less than four days. After every appli- 
cation, the part is to be well dried, and covered with leather. 

In some cases, tonics and astringents have had the best 
effect ; such as diluted muriatic acid, tincture of myrrh, salt 
and vinegar, etc. If these fail, spirits of turpentine and .bal- 
sam copaiva, equal parts, or chloroform liniment, may be tried. 

As the enterprise peculiar to our people is prompting 
multitudes to penetrate our uninhabited northern latitudes, 
where they will inevitably be exposed to extremes of low 
temperature, we think it advisable to be somewhat explicit 
in our directions with regard to the best means of prevent- 
ing the often fatal effects of a protracted exposure to a 
very low temperature. This is always greatly increased 
by fatigue. Much of the effect usually ascribed to the in- 
fluence of cold is owing to the exhaustion of the vital 
forces caused by protracted exertion. Such, especially, is 
the sleepiness which is usually given as a sign of impend- 
ing danger from freezing, and persons are warned not to 
indulge in it at the peril of their lives. And this is true, 
if no one be present to arouse the sufferer at the proper 



SUSPENDED ANIMATION. 821 

time ; but it is very certain that under such circumstances 
a few minutes rest and oblivion in sleep will enable the 
system to so far recuperate that the individual may be en- 
abled to make further efforts toward reaching a place of 
safety that would have been impossible without it. There- 
fore, when a party have been unavoidably a long time ex- 
posed to cold, and at the same time having to undergo 
much muscular exertion, the proper way is to stop occa- 
sionally and let all indulge in sleep for from three to five 
minutes, except one who is detailed to arouse the others at 
the proper time. In this way all may be preserved under 
the most unfavorable circumstances, whereas, if they pushed 
on, one after another, perhaps, would have dropped by the 
way, until no one was left to tell the tale. 



ASPHYXIA— SUSPENDED ANIMATION— APPAR- 
ENT DEATH. 

The above heading is intended to include all cases of 
sudden suspension of the phenomena of life, whether from 
drowning, hanging, sun-stroke, the inhalation of irrespira- 
ble gases — as foul air in wells, etc. — or from whatever 
other cause which is capable of suddenly suspending the 
breathing and the action of the heart without destroying 
the integrity of the system. Sudden frights and overpow- 
ering emotions sometimes do this as effectually as drown- 
ing or hanging, and should be treated in the same way. 
The vital principle, or whatever it is which distinguishes 
living from dead matter, always continues for some time 
after the usual phenomena of life have ceased to be man- 
ifest, in cases of sudden or violent death, and very fre- 
quently, if proper means be used before the vital principle 
becomes extinct, the active phenomena of life — namely, pul- 
sation and respiration — may be again established, and death 
be robbed, for a time, of its prey. And perhaps in no 
other instance is it so important that the people should pos- 



822 ASPHYXIA. 

sess the necessary knowledge to act without waiting for 
the aid of medical skill, as in these cases, for a very few 
minutes delay may make the difference between life and 
death, and perhaps, too, of one whose life may be bound 
up in your own, or one on whose life you may lean for 
your own existence. 

We will therefore make no apology for being somewhat 
minute and impressive in our directions for the manage- 
ment of such cases, and we will first consider a case of 
suspended animation from drowning. In this case, besides 
the suspended animation, we usually have the additional 
trouble of water in the lungs, and it will be impossible for 
breathing to take place until this is got rid of; therefore 
the first thing to be done after extracting the body from 
the water is to place it in a position in which the water 
will be discharged from the lungs by its own gravity; that 
is, place the body across a log, a barrel, or your knees, and 
let the face be downward and the most dependent part; at 
the same time gently roll it a little from side to side, and 
occasionally introduce your finger into the fauces, or upper 
part of the throat, and detach any mucous or other matter 
which may happen to obstruct the chink of the glottis, or 
narrow opening into the windpipe. After having thor- 
oughly freed the lungs from water, if no efforts at breath- 
ing be discovered, lay the body on the ground or the floor, 
and gently turn it on its side, a little over on the face, 
then turn it on its back, and continue to do this about as 
fast as a person will breathe when at rest. Do n't hurry, 
as that will prevent success. This motion of the body will 
cause the air to enter and be expelled from the lungs much 
more certainly and naturally than can be done by any 
method of artificial respiration which has ever been devised. 
We are indebted to Marshal Hall for this ready method, and 
no other plan is now pursued by any body who has any 
claim to correct science. The reader. must take for granted 
not our decision only, but that of every scientific writer 
upon the subject, as we can not undertake to give the phi- 
losophy upon the subject. Now, at the same time that this 
manipulation is going on, somebody should be industriously 



SUSPENDED ANIMATION. 823 

engaged in rubbing the body, observing that every motion 
must be made toward the heart. In this way the blood in 
the veins may be forced onward toward the heart, and may 
cause it to act by the stimulus of distension. The heart is 
perhaps the last organ which loses its vitality, and by caus- 
ing it to contract and send the blood into the lungs they 
may be stimulated to action more certainly than by any 
other means. 

A very common error is to resort to heat, as the warm 
bath, hot bricks, etc. Now, these means would naturally 
suggest themselves as proper, and yet correct medical 
science has decided that they are most pernicious. We 
can not go into an extended explanation of the reason of 
this, but will refer the reader to the known fact that ani- 
mals and reptiles which have the power of living either in 
air or water are all of them cold-blooded, and the colder the 
water is the longer they can remain submerged. Then, it 
is well known that cold is a powerful generator of vitality. 
If warmth is decided on it must be positive ; that is, it must 
be so great as to cause a sensation, and this will become 
proper so soon as breathing and the heart's action are fairly 
established, especially applied to the extremities. 

Death by a failure of respiration is occasioned by the 
same condition, whether from choking, drowning, a closure 
of the glottis by spasm, or by being plugged with a piece 
of meat, or by a false membrane, as in croup and diphthe- 
ria; that is, the blood loses its life, turns black, and stag- 
nates in the capillaries. It is perfectly wonderful with 
what rapidity these changes take place, a few seconds only 
being necessary to change the whole mass of bright-red, 
sparkling, living arterial blood into a thick, dark, dead fluid, 
totally incapable of sustaining the phenomena of life for a 
moment. Most emphatically, we live but a moment at a 
time ; none of us possess a fund of vitality more than suf- 
ficient to say farewell; another breath will bring uncon- 
sciousness if any thing but life-giving, atmospheric air 
be breathed. How urgently do these facts impress any 
rational mind with the importance of pure, fresh air! And 
is it to be wondered at, that hundreds shut into a crowded 



824 ASPHYXIA. 

church soon exhaust the vitality of the air to such a degree 
that the brain should feel the stupefying effect of venous 
blood, and the congregation become more sleepy than de- 
votional? 

But, although it is true to the letter that almost a single 
breath of any of what are called irrespirable gases will sus- 
pend the phenomena of life, yet the heart does continue to 
act, and circulates the blood to some extent, for a time 
after all consciousness and sensibility are lost; but the 
blood, though moved through the vessels, imparts no vital- 
ity to the system, but by preventing the blood from be- 
coming stagnant it enables us to successfully use means 
for resuscitation, and they should always be perseveringly 
used as long as there can be the slightest hope of success. 
Cases have been reported in which, after half an hour's 
effort, the patient revived. The shock which the system 
has received will make it necessary to enjoin perfect rest 
and quietness for some time after resuscitation, and some 
light nourishment and mild stimulants should be given; 
and, if reactionary fever should follow, it should be abated 
by sponging the surface with tepid water, and cooling 
purgatives. 

In cases of coup de soliel, or sun-stroke, after conscious- 
ness is restored an anodyne will be necessary, and if giddi- 
ness of the head, ringing in the ears, etc., should continue 
for more than a few hours, cold water should be often 
applied to the head, and two small blisters drawn behind 
the ears. 

Suspended animation, and even death, may be caused 
by a very different condition of the circulation — namely, 
by fainting, or syncope. In this case consciousness is lost 
from a failure of the blood to reach the brain, and not from 
its being poisoned by carbon. In fainting the surface is 
deadly pale, whereas in coma, or loss of consciousness from 
the presence of black or venous blood in the arteries, the 
surface is always purple, often quite black. In cases of 
fainting the patient should immediately be placed in a hor- 
izontal position, and if possible the head should be lower 
than the body, so that the force of gravity may induce the 



SUSPENDED ANIMATION. 825 

blood to flow into the brain, for it is the want of blood in 
that organ which has suspended the phenomena of life. 
Nothing will act quicker and with an equal certainty in 
fainting than, after turning the patient on his belly, to 
strip the back naked and flagellate smartly with a hand 
ful of small switches. 

How long a person may remain under water and be re- 
suscitated is very uncertain. Sometimes a few minutes 
destroys life, and yet there are well-authenticated cases in 
which the person has been submerged for half an hour, 
and afterward revived. Vigorous efforts should, therefore, 
always be made when there is the remotest probability of 
success. As soon as the patient has fairly revived he 
should be removed to some comfortable place and put to 
bed, and have some warm cordial drink given him, as hot 
whisky punch, hard cider with ginger, heated by immers- 
ing a hot iron in it, etc. 

Other instances of asphyxia, or apparent death, whether 
from hanging, foul air, etc., must be managed precisely as 
from drowning, except that the means for getting clear of 
the water on the lungs are not necessary. The manage- 
ment of still-born infants will be considered in the chapter 
on midwifery. 



826 MIDWIFERY. 



MIDWIFERY. 



Under the head of midwifery is commonly included a 
brief notice of the female reproductive organs ; the diseases 
to which her sex renders her liable ; the diseases growing 
out of pregnancy and childbirth, and those which may suc- 
ceed as a consequence; midwifery proper, or the management 
during parturition or childbirth ; and the management of the 
infant, and the treatment of its diseases. 

We will conform to this custom, but cannot be expected 
to enter much into details or minutiae, as that would swell 
this work to an inconvenient size. All we intend in regard 
to practical midwifery is to give some plain directions, which 
may serve to enable a sensible person to render proper 
assistance in the absence of an experienced midwife or sci- 
entific accoucheur. In the absence of a physician it is often 
an absolute necessity that those unacquainted with the de- 
tails should superintend a delivery. Hence the necessity 
of including practical midwifery in this work. 

As the history and treatment of diseases peculiar to fe- 
males constitute the most important part of a work designed 
for family reference, they will receive full justice, even at 
the expense of rendering the work larger than was at first 
intended. But the reader will not object to this, if the 
pages are found to be filled with interesting and useful 
matter. 



FEMALE REPRODUCTIVE ORGANS. 827 



CHAPTER I. 

A SKETCH OF THE ANATOMY OF THE FEMALE REPRODUCTIVE 

ORGANS. 

The pelvis is composed of five bones, viz. : the sacrum, 
or arch bone ; the innomenati, or two side bones ; and the 
coccyx, or crupper bone. 

The os sacrum forms the posterior or hinder part of the 
pelvis, or basin, and is attached, above, to the last lumbar 
vertebra, or backbone, of which it is really only a continu- 
ation; below, it is attached to the os coccyx, and at each 
side to the os innomenati. Like the backbone, it is hollow, 
for* the purpose of receiving the spinal marrow, and is per- 
forated with many holes, both in front and behind, which 
give passage to the nerves that proceed from the spinal 
marrow, and are sent to the lower extremities, and to the 
organs contained within the pelvis. Now, as the nerves 
which issue from the holes, or foramen, on the front or in- 
side of the sacrum are subject to be pressed upon by the 
contents of the pelvis, it is easy to account for the various 
pains and aches experienced in the lower part of the back, 
from the pressure of hardened faeces in the rectum or lower 
gut; from the womb in pregnancy, or when swollen and 
hard from disease; and from polypi or other tumors. 

The coccyx is attached to the sacrum above, and is loose 
below, and serves to taper off the spinal column and afford 
some support to the contents of the pelvis. 

The os innomenati form the sides of the pelvis, and are 
attached behind to the sacrum, and in front to each other. 
Each of these bones is composed, in infancy, of three sepa- 



828 MIDWIFERY. 

rate bones, which do not become firmly united until puberty, 
or when the individual has ceased to grow. 

These pieces have received separate names, and are de- 
scribed as separate bones, under the designation of os pubes, 
or share bone, os ischium, or hip bone, and os ilium, or 
haunch bone. The ilii, or wings, form the upper part, or 
brim, of the pelvis ; the ischii, the lower part, and have two 
prominences, known by many as the huckle-bones, on which 
we chiefly rest when sitting; and* the os pubes forms the 
front of the pelvis ; and all three of these bones unite in 
forming the acetabulum, or socket of the thigh-bone. 

A minute description of the bones of the pelvis would 
be quite unprofitable in a work of this kind, as it could not 
be understood without the aid of the bones themselves to 
look at, and a teacher to point out the various parts. But 
this much was necessary in order that the reader might 
have some definite idea of the locality of parts when spoken 
of with reference to these bones. And as the soft parts con- 
nected with or contained in the female pelvis are necessarily 
referred to in treating of the diseases to which they are in- 
cident, some observations on their structure, form, locality, 
and the functions they perform, also become essential to an 
understanding of the nature and treatment of the diseases 
and misfortunes peculiar to the female organization, and es- 
pecially of those growing out of the relations of wife and 
mother. These parts will therefore be described as deli- 
cately and as concisely as is consistent with our main object, 
of being understood. 

THE EXTERNAL ORGANS. 

The term pudenda refers to all those parts of the repro- 
ductive apparatus which are situated upon the outer part of 
the pelvis. 

Mons, or mons veneris, (mountain of Venus,) is the ele- 
vation or fleshy prominence upon the os pubes, or share 
bone, or front bone. The mons becomes still more promi- 
nent than it would be from a mere projection of bones at 
this place, from a collection of adipose or fatty material 
below the skin at that point, together with the hair which 



FEMALE REPRODUCTIVE ORGANS. 829 

covers this part of the surface ; which caused it to receive. 
in ancient times, the appellation of mons. 

About an inch and a half of the most projecting part of 
the front bone is known as the symphysis of the pubes ; 
only the upper part of the symphysis is covered by the 
lower part of the mons, the lower part being occupied with 
the commencement of the genital fissure, or vulva, and is 
covered with the mucous membrane, which lines all the in- 
ternal organs that have an external opening. 

The derm or skin which covers the mons passes down on 
either side of the symphysis, leaving the genital fissure bor- 
dered on the right and left by the labia majorum, or great 
lips of the pudenda. 

These labia are covered with ordinary skin on their outer 
surfaces, but are lined on their inner sides with mucous 
membrane ; and, passing downward and backward, they are 
at length lost, or disappear in the perineum, which is the 
dense structure forming the lower part of the partition be- 
tween the rectum, or lower bowel, and the vagina, or ute- 
rine canal, and performs important offices in connection with 
pregnancy and child-bearing, and will often be referred to. 

Like the human lip, the skin on the outer side of the 
labia majorum changes insensibly into the mucous membrane 
which lines the inside, so that there is no distinct line of 
demarcation. 

Like the mons, these outer lips are covered with hair, 
and supplied with numerous sebaceous glands, which, as in 
other situations, secrete an oily material for preserving pli- 
ancy to the parts. They also have a store of adipose or 
fat cells, though not as numerous as the mons. 

The areolar or cellular tissue, lying between the external 
and internal surfaces of the labia, is extremely loose and 
distensible, and yields very readily to any injecting force ; 
hence these parts are subject to great distension from drop- 
sical effusion during the latter months of pregnancy, which 
often seriously interferes with delivery, but are easily re- 
lieved by making several small punctures with the point of 
a sharp lancet on the inner side of the labia. These punc- 
tures cause no pain, nor are they attended with the least 



830 



MIDWIFERY. 



danger ; and, as they allow an easy exit for the water, and 
very soon remove the swelling, this simple measure should 
never be omitted when the swelling is considerable. 

Bruises, or the pressure of the head of the child in labor, 
occasionally cause a rupture of some of the blood-vessels 
in the labia, and they speedily become greatly enlarged by 
a collection of blood. A puncture should be immediately 
made, as the blood, by being retained, may occasion a very 
troublesome abscess. If an abscess be threatened from this 
or any other cause in these parts, it should be promptly 
treated, and, if possible, prevented, as the extreme looseness 
of the textures renders ulcers here very troublesome, and 
difficult to cure. 

The nymphce, which are called labia minora, or little lips, 
or labia interna, or inner lips, are two folds of the inner 
mucous membrane, like two flaps or valves, which are joined 
together at their upper ends about an inch within the 
external fissure, and extend downward, embracing the 
clitoris on each side, and, passing backward, are lost in the 
common lining of the vagina. They are loose and vascular 
in their structure, and probably serve the important pur- 
pose of allowing a greater degree of distention at the time 
of delivery. What is called the vestibule is a depression 
immediately behind or below the point where the nymphse 
meet and the orifice of the urethra. The operator, there- 
fore, when it becomes necessary to introduce the catheter, 
by recollecting that the orifice of the urethra may be found 
directly behind the junction of the nymphae, and that a 
little tubercle or eminence may be felt on the lower margin 
of the opening into the urethra, can have no difficulty in 
finding the exact point into which to insert the catheter 
without annoying the patient by fumbling, or having to call 
for a light. The correct manner of procedure in intro- 
ducing the catheter is as follows. The lady should lie 
across the bed, with her hips near the side, and her knees 
drawn up, and feet placed against the bed-rail ; the operator 
should introduce his left fore-finger into the lower or hinder 
part of the fissure, and bring it up until it touches the 
prominence under the front bone; then move the finger 



FEMALE REPRODUCTIVE ORGANS. 831 

forward until he feels that it has passed over the little 
knob at the urethral opening, and ascertains that the finger 
rests in the little depression or vestibule ; then with the 
right hand the catheter may be directed between the finger 
and the surface on which it rests, and cannot fail to enter 
the canal of the urethra. But after a hard labor, these 
parts are so much changed that the most expert operator 
often finds great difficulty in ascertaining the exact point 
against which to press the instrument, and at this time it 
will be better, after making a few unsuccessful efforts, to 
have u light upon the subject," rather than occasion injury 
by blind efforts, or to let the patient suffer from an over- 
distended bladder. 

Cohesion of the Labia. — In young children the lining 
membrane of these parts sometimes becomes inflamed, and, 
if care be not taken, they may unite and grow together ; but 
the attachment is not usually strong, and can easily be broken 
up, and the parts separated, by pressing firmly with the 
finger; an oiled rag should be now placed between the 
surfaces to keep them apart until the mucous membrane 
has healed. 

The Fourchette. — The labia majorum are partly lost in 
the perineum, and are partly fused or joined with each other, 
and where they unite there is a sort of seam, something 
like a scar from an incised wound, which by the French 
has been named fourchette. Inside of this fourchette is a 
depression or cavity that is concealed until the fourchette 
is pulled forward and depressed ; this little pocket-like 
depression is called fossae navicularis, or boat-shaped pit, 
behind which is the vaginal valve, or fold of membrane, 
known as the hymen, the mark or sign of chastity recog- 
nized by the law of Moses, but now admitted to be often 
wanting, even in early girlhood. 

The hymen, we have said, is nothing more than a fold, or 
duplicature of the mucous membrane of the vagina; in some 
cases it is almost wholly wanting, but in others forms nearly 
a complete partition across the vaginal canal, terminating 
just behind the orifice of the urethra, and only having an 
opening sufficient to admit of the passage of the catamenia, 
53 



832 MIDWIFERY. 

or menstrual discharge ; and even this is occasionally want- 
ing, which forms what is called imperforate hymen, and, if not 
remedied, will give rise to very serious consequences when 
the girl comes to menstruate. The remedy, of course, is to 
divide the membrane, but we will speak more of this in 
another place. 

The Clitoris. — From the under sides of the ossa pubes, or 
share bones, there arises a spongy body, composed princi- 
pally of blood-vessels, which proceed along the bones until 
they meet each other, and, uniting, form a projection, which 
is very noticeable in children. When these spongy bodies 
which form the clitoris happen to become pierced by falls 
on sharp bodies, the bleeding is sometimes dangerously pro- 
fuse. I was once called to a lady who, in clambering over 
the foot of the bed, fell on the top of a little chair that 
happened to be in her way, and received a wound in this 
part which came near costing her life. Compresses dipped 
in alum water, and bound firmly to the wound by the T 
bandage, finally arrested the hemorrhage. 

The Vagina. — Having given some account of the external 
reproductive organs, we will next notice the vagina, which, 
as it forms a canal leading from the vulva, or external 
orifice, to the uterus, or womb, is partly an external and 
partly an internal organ. 

The vagina may be considered the excretory duct of the 
uterus, as along it passes the menstrual flux, mucous secre- 
tions, and all other discharges from the womb ; and it is 
composed of such dilatable tissues, that although, in the 
virgin, it is less than an inch in diameter, yet it is capable of 
giving passage to a fully developed foetus. The vagina is 
lined by a mucous membrane, which appears not to possess 
a high degree of sensibility, or life-force ; hence it is liable 
to few diseases, and possesses but a feeble power over other 
organs through sympathy ; in this it differs from almost all 
the other sexual organs. 

The Womb. — The uterus is situated at the termination 
of the vagina ; it is pear-shaped, placed with its smaller end 
down; it is from an inch and a half to three inches in 
length ; and is divided into its fundes, or upper portion, its 



FEMALE REPRODUCTIVE ORGANS. 833 

body, or middle portion, and its cervix, or neck, which 
forms its lower portion and extends partly into the vagina. 
The direction of the vaginal canal is backward and upward, 
but the womb stands nearly perpendicular, so that at their 
junction they form a considerable angle, and hence the 
cervix, or neck of the womb, which extends into the 
vagina, appears to dip into it upon its upper side, and there- 
fore, when making a vaginal examination, the end of the 
finger does not come in contact with the mouth of the 
womb, but it is felt projecting downward from above. 
Now this being the natural relation which subsists between 
the uterus and vagina, when any other obtains, it may be 
known that the womb is misplaced. We will again refer to 
this when we come to treat of uterine misplacements. 

The walls of the uterus are about an inch thick, and are 
composed of its mucous lining, contractile fibres, nerves, 
blood-vessels, absorbents, and an outer serous covering, 
composed of an extension or reflection of the peritoneum 
from the bladder, rectum, etc. 

The mean length of the womb being about two and a half 
inches, and as it projects near half an inch into the vagina, 
about two inches must therefore project above the vagina, 
and is held in its place by its peritoneal attachments to 
other organs and to the pelvis. A duplicature of the peri- 
toneum passes off from each side of the uterus to the brim 
of the pelvis, and serves to steady it and prevent it from 
assuming an oblique direction to the right or left; two 
other folds pass forward and are attached to the bones near 
( each groin, which prevent it from becoming tilted backward 
against the sacrum, and the bladder prevents it from falling 
forward. But these means often fail in relaxed conditions 
of the system, or when some unusual force is applied, in 
keeping the womb in place, all of which accidents will be 
noticed in their proper place. 

The Ovaries. — On each side of the womb, but disconnected 
from it, lie enfolded in the peritoneum the germinal or egg- 
producing organ called ovary. They are granular-looking 
bodies, of about an inch in length, and not quite so broad, 
and somewhat flattened on each side. It is in these bodies 



834 MIDWIFERY. 

that impregnation takes place ; or, at least, from these the 
ova or egg proceeds, which serves as the starting-point in 
the progress of the development of a new creature. The 
loss of these little organs absolutely disqualifies the female 
from becoming pregnant ; it does more than that, it unsexes 
her. Farmers understand this, and by removing the -.pride 
from female swine, not only disqualify them from breeding, 
but destroy all sexual feeling ; and the speyed sow and the 
barrow alike occupy a neutral position — neither partaking 
of the form or propensities peculiar to sex. But as the 
ovaries are outside of the womb, and have no direct com- 
munication with it, how, it may be asked, can the ovum or 
egg obtain admittance into the uterus ? This is accom- 
plished by a very singular contrivance : there projects from 
each side of the fundes of the womb a round body called 
the fallopian tube, which near the uterus is enfolded by 
the peritoneum, but its outer extremity is free, and hangs 
loose in the cavity of the peritoneum; this loose end is 
fimbriated, or fringed, much like the bloom of the wild 
apricot. Now this body contains a duct or canal which 
communicates with the cavity of the uterus ; at its free 
extremity this canal is large enough to admit the end of 
one's little finger, but grows narrow as it approaches the 
womb, until at its entrance it will not more than admit an 
ordinary-sized pin. 

Now, during the orgasm or excitement at the menstrual 
period, one or more of the little ova or eggs in the ovary 
becomes matured, and the absorbents cut a passage through 
the investing tissues for its escape ; and, under a certain 
state of excitement, the fallopian tubes become engorged 
with blood, so as to put them on a strut, which brings their 
fringed ends precisely in contact with the ovaries, and these 
fringes embrace it like so many little fingers, and for the 
time hold the mouth of the tube in such nice contact with 
the ovary, that it serves as an excretory duct to this organ ; 
or may transmit to them, through the medium of the womb, 
the vital impulse by which the ovum is impregnated, and 
become the punctwn saliens of a new existence. 

But whether the ovum is usually impregnated before en- 



FEMALE REPRODUCTIVE ORGANS. 835 

tering the fallopian tube, or during its passage along the 
tube, or after it has reached the uterus, are controverted 
points ; but it is certain that this event does sometimes 
take place before the egg reaches the womb, as the foetus is 
occasionally developed in the ovary, or in the common 
peritoneal cavity, or in the fallopian tube, and entirely 
outside of the womb, forming what is known as extra 
uterine pregnancy. It seems that after an ovum is once 
impregnated, it contains within itself the power of develop- 
ment ; and when in contact with any moist living tissue, 
whether that be a mucous surface, as in the womb, or fallo- 
pian tube, or a serous membrane, as the peritoneum or cel- 
lular tissue, as in its bed in the ovary, it can attach itself 
and draw nourishment from the living tissue, forming for 
itself all the necessary appurtenances for complete develop- 
ment, as placenta, investing membranes, liquor amnii, etc. ; 
a mystery which man will wonder over to the last of his 
inquisitive race, but will never comprehend. 

Ordinarily, the egg passes along the fallopian tube until 
it reaches the womb, and makes an attachment at the 
fundes, near its entrance ; but sometimes it falls down, 
and becomes attached to the neck of the womb, and its 
placenta becomes spread out over the os uteri, or mouth of 
the womb, and occasions great danger from flooding at the 
time of delivery, as the after-birth must necessarily become 
detached before the child can leave the uterus. 

It would afford the author pleasure to pursue this inter- 
esting subject through all the marvellous workings of na- 
ture, by which a thing that " was not" becomes a living, 
acting, thinking, and immortal being; but space will not 
admit of such amplification, as we have already exceeded 
the limits contracted for, and have yet much to say upon 
important practical subjects — subjects involving the health 
and lives of our fair friends and of their precious little ones. 
We will therefore proceed to the consideration of some of 
the diseases to which the peculiar organization of the female 
renders her liable. 



836 MIDWIFERY. 



CHAPTER II. i 

FEMALE DISEASES. 
MENSTRUATION. 

At a certain age, the girl arrives at a period called puberty, 
at which time, if in health, she assumes the form and takes 
on the performance of the functions peculiar to woman. 
Among these is menstruation, which consists in a sanguineous 
or bloody secretion from the womb, occurring periodically, at 
intervals of about twenty-eight days. This discharge is 
known among the women by various appellations : as 
courses, menses, catamenia, monthly sickness, times, unwell, 
etc. ^ 

The time of the catamenial visitation, or of Menstruation. — 
The period of menstruation is an important one, and should 
be well understood by mothers, that they may be the better 
enabled to give the proper advice to their daughters in the 
development of this process. Mothers too often neglect this 
important point of health, and thus lasting if not incurable 
disease is brought upon the daughter. 

Great difference exists as to the period at which females 
menstruate, not only in different countries, but in our own. 
The catamenia or menstruation generally appears at or about 
the age of fifteen years ; but it appears much earlier in 
some, and is delayed much longer in others. These varia- 
tions will be found to correspond with the proportionate de- 
velopments of the body and the genital system. 

All medical writers agree that the warmer the climate, the 



MENSTRUATION. 837 

earlier the catamenia will appear ; and the colder the climate, 
the longer it will be deferred. It is said to make its appear- 
ance in the East Indies as early as at the eighth or tenth 
year ; but in Greenland it does not appear before the twen- 
tieth or twenty-second year of age. 

Its duration is pretty equal in all climates. The women 
in hot climates, who menstruate early in life, become old 
proportionably soon. 

In a perfectly healthy female, the catamenial discharge is 
thrown off without pain or suffering; but in the present 
state of society this is not generally the case. Most com- 
monly, for some days previous to its appearance, the girl 
has a pain in her head, with general languor and heaviness. 
She feels indisposed to use much exercise ; has some pain 
in the back, loins, and down the thighs ; and occasionally 
she experiences some uneasy sensations in the throat. 
There is a peculiar dark shade over the countenance, and 
especially under the eyes ; the perspiration has a faint, 
sickly odor; the breasts enlarge a little, and are more or 
less painful ; the digestion is apt to be somewhat impaired ; 
the appetite is variable, and frequently not very good. 
After these symptoms have been present for a day or two, 
the catamenia appears, and the uneasiness diminishes. It 
occasionally happens that the first and sometimes the second 
period passes without any discharge, and the health is not 
impaired. 

The period of this discharge is from three to six days, 
and from three to six ounces of fluid are discharged during 
that time. The catamenia, to be regular, ought to return 
every twenty-eight days in girls and unmarried ladies. 

Some persons suppose that every discharge from the va- 
gina that is tinged with blood is a menstrual discharge ; but 
this is not true. Every discharge from the vagina that clots 
is not menstrual : all that portion that clots is hemorrhage, 
and that portion which does not clot is menstrual. Keep- 
ing this fact always in your mind, you may be ready, in a 
moment, to decide whether the discharge is a secretion or 
hemorrhage. 

The menses are always secreted in the same manner as 



838 MIDWIFERY. 

the sweat is secreted from the skin, and they never come 
away in lumps, but always in a fluid state. The discharge 
is at times thicker and darker than it is at other times, 
owing to the retention of the fluid in the vagina after it is 
secreted and before it is discharged. Sometimes it appears 
in shreds and strings, when it has laid longer, and is still 
darker. The cause of the dark and stringy appearance of 
the catamenia is that the fluid part of the blood is absorbed 
before the discharge takes place. 

Menstrual blood has a peculiar smell, differing from the 
odor of any other blood. 

The menstrual function is of much importance to the fe- 
male. By the healthy functions of the uterus it is prepared 
for the propagation of our species, and when the uterus does 
not perform its proper functions, barrenness is always the 
result. 

The healthy action of the system, and general good 
health, and soundness of the constitution, depend much 
upon the healthy functions of the uterus. Females, then, 
and especially young girls, should be extremely careful of 
themselves during this process ; and mothers should be par- 
ticular with their daughters on this subject, and know that 
these things are all right with them. 

Neither girls nor married women should change their 
clothing, so as to be liable to take cold, or produce a check, 
during this process. They should by no means put on 
any garment that is wet or damp during this time, and 
should be careful to keep their feet warm and dry. 

Some girls are so imprudent that they will place their 
feet in cold water, or expose their feet and legs to the cool 
air, to check the menses, in order that they may be able to 
pay a visit, or attend a ball. This practice is but little 
better than suicide, often laying the foundation of disease, 
which terminates in death, after an incalculable amount of 
suffering. An imprudent check of the menses by cold often 
lays the foundation of incurable consumption. 

Seeing, then, that much depends, in future life, upon the 
regular establishment of the menses, and a strict regard to 
their uninterrupted and healthy functions, too much care 



NEGLECT OF THE MENSTRUAL FUNCTION. 839 

cannot be taken on this subject. If, by accident or some 
unavoidable cause, the menses should be checked, xhey 
should be restored as soon as possible. For this purpose, 
place the feet and legs in warm water, and, at the same 
time, sit over a vessel of warm water, with or without some 
bitter herbs boiled in it, and remain there till you are in a 
free perspiration ; then wrap up in bed, and take a teacupful 
of warm tea made of the root of vervine or pennyroyal. 
This draught may be repeated every half hour till the dis- 
charge returns. Cloths wrung out of hot mustard-water, 
or a poultice of mush sprinkled with mustard, should be 
applied to the abdomen, and renewed as often as it becomes 
cool. This is a powerful means of exciting the flow, and, 
with the other means recommended, rarely fails of entire 
success, if used early. 

If this should fail, take the following pills : Gum myrrh, 
compound extract of colocynth, castile soap, each ten grains ; 
make eight pills ; take two every three hours. They may 
be worked off w T ith warm gruel. 

But should neither of these medicines be at hand, six or 
eight pills of the extract of white walnut, (butternut,) or 
a dose of castor oil, may be taken. 

OF THE CONSEQUENCES ARISING FROM THE NEGLECT OF THE 
MENSTRUAL FUNCTIONS. 

It is of the most vital importance that the functions of 
the system be established in a healthy manner, in order to 
the full and healthy development of the body and constitu- 
tion, and there is no one function of the system that involves 
the general health more than that of the uterus. The order 
of nature is such that the functions of this organ must be 
performed in due time and in a healthy manner ; otherwise, 
the general system will, sooner or later, suffer from this 
defect. 

When the functions of the uterus should be developed, 
according to age and constitution, if they do not fulfil what 
nature demands of them, some other organ, of equal and 
perhaps of superior vital importance, will act vicariously or 
sympathetically, and strive to supply the place of the na- 



840 MIDWIFERY. 

tural and healthy functions of the organ that fails to do its 
duty. How often do we see the lungs taking on a sympa- 
thetic action to supply the functions of the uterus ! But, 
by supplying this vicarious discharge, the lungs may suffer 
violence in their structure, and the result has often been 
pulmonary consumption. If the functions of the uterus 
are neglected, we may always look for the lungs to bear a 
fearful part in sympathy with that organ. 

Should there be a scrofulous diathesis or taint in the sys- 
tem, and the functions of the uterus not be performed in a 
healthy manner, we may look for the speedy, and perhaps 
fatal, development of scrofula. 

The stomach and liver also bear a heavy portion of the 
morbid train of action arising from the want of a healthy 
development of the functions of the uterus. Liver com- 
plaint, dyspepsia, and all the concomitant train of symp- 
toms, follow. The lymphatic system is sure to suffer, and 
dropsy may be the result. 

When we take all these things into consideration, how 
important is it that mothers should attend strictly to the 
healthy development of the menstrual functions ! It is the 
duty of the mother to explain these things to her daughters, 
and have the first appearance of derangement attended to, 
before the foundation of more serious consequences is laid. 
A neglect of these things places too much at stake ; and 
strict attention should therefore be given to this matter. 

If the means used should therefore fail to bring on the 
courses at the time, measures should be taken to secure its 
occurrence at the next regular period. The most certain 
means for this purpose, according to my experience, is the 
compound syrup of butternut, or anodyne alterant, given 
under the head of dyspepsia. A teaspoonful of this should 
be taken after each meal, and continued until there are 
symptoms of the menstrual effort taking place, or until the 
period has arrived when it should take place ; now give a 
tablespoonful at once, and aid it by all the means before 
recommended, as the foot-bath, steaming, hot cloths, etc. 

But if these should all fail, or only succeed in procuring 
a scanty discharge, continue the alterant through another 



RETENTION OF THE MENSES. 841 

month, and, a few days before the regular period, commence 
the use of the tincture of black hellebore ; from five to ten 
drops should be taken, in a wineglassful of sweetened water, 
every three hours, and all the other means used as before 
directed. This course has never failed me, except in com- 
plications with some other formidable disease. 

RETENTION OF THE MENSES AMENSIA. 

This disease is often confounded with suppression of the 
menses ; but there is this difference : retention is where 
they have never appeared, though the proper time of life 
has arrived. A retention of the menses may be produced 
by various causes, such as a feeble state of the system, a 
defect in one or both of the ovaries, the uterus not being 
developed, etc. At other times the ovaries are entirely 
wanting, and then the catamenia never appear. The patient, 
in this case, is usually robust, and her voice rather on the 
masculine order, or deep and hollow. She has no breasts, 
or they are small. 

Constitutional diseases, such as scrofula, consumption, 
diseases of the liver, etc., may prevent the appearance of 
the catamenia. The os uteri is sometimes closed; in this 
case, the regular menstrual feelings are present every month, 
but the fluid does not escape. In other cases the vagina is 
closed, having adhered together from inflammation produced 
by erysipelas, or injuries of some kind, such as falls, etc. 
The hymen is, at times, imperforate, and the escape of the 
fluid prevented. 

Treatment. — The treatment of retention of the menses 
must necessarily vary, according to the nature of the dis- 
ease, and the cause which produced it. The remedy to be 
used when the hymen is imperforate, is to divide it. This 
membrane is sometimes so strong as to retain the menses 
till they distend the womb, and the girl may present the 
appearance of being pregnant. 

The same thing may occur by the adhesion of the walls 
of the vagina. When the mouth of the womb is closed, it 
must be divided by the use of a proper instrument; after 
which, a very small bougie should be introduced into the 



842 MIDWIFERY. 

womb ; but great care is necessary in the performance of all 
these operations, and none but a skilful surgeon should at- 
tempt them. 

After these obstructions are removed, the case must be 
treated as the constitutional symptoms demand. When the 
retention is produced from the want of a sufficient develop- 
ment of the constitution, those remedies that are calculated 
to develop and perfect the system must be used. A gener- 
ous diet, such exercise as the patient can bear, and lively 
company, will best accomplish this end; but the patient 
must wait till nature is prepared to do her work. No forc- 
ing medicines should be used at this time ; but the use of 
the anodyne alterant is peculiarly appropriate in this case, 
as it will improve the general health and tone of the system, 
and prepare it for the performance of this important func- 
tion. 

When the retention is produced by any constitutional 
disease, that must be removed by using the appropriate 
remedies. 

When it is the result of a defect in the ovaries, the 
menses never can be brought on. When there is only a 
partial development of these organs, a partial secretion may 
be induced by bracing and strengthening the system, but it 
will always be imperfect. The patient will never bear 
children, and it is better for her not to marry. 

SUPPRESSION OF THE MENSES AMENORRHEA. 

When the catamenial discharge has once been established, 
and afterwards ceases to return, from any other causes than 
pregnancy or the change of life, it is said to be sup- 
pressed. This may arise from various causes ; diseases in 
other organs, by monopolizing, as it were, the excitement, 
may prevent the determination of blood and nervous fluid 
to the sexual organs necessary for getting up the orgasm of 
the ovaries and uterus, which seem to be the immediate 
cause of the menstrual secretion. In these cases, the prin- 
cipal disease must claim our attention ; but something can 
often be done at the menstrual period which may solicit the 
discharge, such as the warm hip-bath, mustard to the 



PROFUSE MENSTRUATION. 843 

thighs, drinking warm teas, etc. But the suppressions 
which most often claim our attention are the result of 
exposure to wet and cold, especially of the feet, about the 
time of the flow taking place. In spite of all the counsel 
that may be given by the physician, and backed by parental 
influence, girls will often persevere in being imprudent ; as 
they feel well, they cannot realize the danger of these little 
exposures making them sick, and they will persist in 
putting their feet upon cold, damp ground, with nothing 
adequate to protect them from the pernicious influence of 
cold and dampness ; and I suppose they will continue to do 
this after they have read this article, and would were I to 
write a volume upon the subject and they should read it. 
I will only add, therefore, that after such exposures, if the 
courses should be suspended, they should lose no time in 
the use of the proper means to bring them on. What has 
been said under the general head, and in retention of the 
menses, will apply here, and need not be repeated, as the 
hot mustard hip-bath, cloths wrung out of hot mustard 
water to the abdomen, the warm teas, etc., used at the 
time ; and if the courses should not appear under their influ- 
ence, then take a dose of calomel and work it off with 
castor oil ; or, in place of the calomel, take a full dose of 
Cook's pills, which are better, and will work themselves off. 
The discharge from the liver and bowels will in some 
measure supply the lack of the courses, and prevent much 
injury from following; at the next period all the means 
recommended for bringing on the courses should be used as 
before ; and if there be another failure, then give the purga- 
tive' and commence the use of the anodyne alterant, and 
take it as directed in another part of this chapter, not 
forgetting to aid it at the last with the tincture of black 
hellebore. 

PROFUSE MENSTRUATION. 

If the discharge be a real hemorrhage from the womb, 
which may be known by its greater redness and by its 
coagulating or forming clots, it must be treated as such ; 
(see Hemorrhage from the Womb;) only an excessive 
secretion of the true catamenia is intended to be ex- 



844 MIDWIFERY. 

pressed by the term profuse menstruation. This is almost 
always the effect of general weakness and relaxation, 
the general treatment of which may be found under 
the head of Chlorosis, and consists of all those means 
which tend to invigorate the health. During the period, 
perfect quietness should be observed; the feet must be 
kept warm by hot dry flannels, or some other means that 
will not produce steam; mustard may be applied to the 
arms, and half a grain of opium given twice or thrice a day ; 
I say opium, for paregoric or Dover's powder, and even 
morphine, have a tendency to increase secretion. If these 
means should fail to keep the discharge moderate, cloths 
saturated with cold whiskey, in which alum has been dis- 
solved, may be applied to the pubes and vulva ; there is no 
danger of taking cold from this application and producing a 
suppression. 

Profuse menstruation rarely observes the regular periods 
for its return, but comes on every twenty-two or three days, 
though some women have a, return every two weeks — not- 
withstanding which, they become pregnant; but cases of 
this kind are rare. 

The radical cure, we have said, is to be performed by 
using proper remedies during the intervals ; and these 
remedies are, a generous diet, and moderate but regular 
exercise, either on foot or on horseback. The patient 
should take strengthening medicines, such as the chaly- 
beates and vegetable bitters. The copperas pill is an excel- 
lent remedy, but pills made of the prussiate of iron and 
assafoetida have succeeded better in my hands than any 
other means ; equal parts should be used, and a common- 
sized pill taken three times a day. 

Where the menses are profuse, and the patient full of 
blood, with a rigid fibre of muscle, the treatment should be 
different, both in the attack and in the interim. During 
the attack she should be purged freely with epsom salts, and 
between the terms should live lightly, and keep the bowels 
cool by taking small portions of salts and cream of tartar. 

PAINFUL MENSTRUATION. 

This form of disease has many varieties, all of which we 



PAINFUL MENSTRUATION. 845 

shall treat of in regular order, and give the symptoms and 
treatment for each in its place. 

The distinctive mark of this disease is the pain which is 
experienced before the discharge appears, and during its 
continuance. The discharge itself may be scanty, or of 
proper quantity. The amount of pain varies very much in 
different individuals, and in the same individuals at different 
times ; it may be moderate, and last only a few hours at 
each menstrual period, or it may be so severe as to cause 
fainting, and, by repeated shocks, break down the constitu- 
tion and entirely destroy the patient's health. The cha- 
racter of the pain and its accompanying symptoms vary 
according to the constitution of the subject; and on this 
ground the disease may be divided into three forms — the 
nervous, the inflammatory, and the mechanical. 

Difficult menstruation may occur at any menstrual period, 
and it is rarely confined, after it has occurred, to one or 
two periods only. In some cases it may be traced back to 
the commencement of menstruation, and occasionally it 
continues through the whole of menstrual life. 

First. — Nervous painful menstruation may attack females 
at any age, but the attacks are more frequent after the 
thirtieth year than before that period. It is to be found in 
unmarried women, and in married women who have not 
borne children, more frequently than in those who have. 
It is almost exclusively confined to those of a nervous 
temperament, and thin delicate habit. 

The monthly paroxysms present all the peculiar charac- 
teristics of an irritable state of the nervbus system. A 
day or two before the paroxysms come on, there is a sensa- 
tion of general uneasiness, and a deep-seated feeling of 
cold; some patients say their bones feel icy cold. A pain 
in the head may precede or succeed the discharge, and 
sometimes the pain in the head and back alternate. 

When the pain is in the back, it commences low down, 
extends round to the abdomen, and down the thighs. 

In some cases but a few hours elapse after the pains 
commence until the menses appear ; while in others it will 
be a day or two. These pains are generally attended with 



846 MIDWIFERY. 

a sense of bearing down, which adds much to the suffering 
of the patient. Finally, the menses appear, sometimes 
slowly, and sometimes in slight gushes. The quantity 
varies in different persons, and in the same person at differ- 
ent times. 

The discharge is sometimes dark, and at other times paler 
than usual, or mixed with small clots. There is at times a 
peculiar membrane discharged, composed of plastic lymph, 
such as we see thrown up by children laboring under croup ; 
it generally takes the shape of the inner surface of the 
uterus, but it is sometimes discharged in shreds. 

When the figure of the uterine cavity is preserved, it 
may give rise to suspicions of pregnancy, and some igno- 
rant persons have defamed the character of girls and 
widows on seeing this membrane. But such defamation 
arises from a want of knowledge, for the discharge of this 
membrane is no proof of a want of chastity. The expul- 
sion of this deciduous membrane is attended with pains like 
those of labor. 

Some patients discharge this bag at every menstrual pe- 
riod, while others only discharge it occasionally. Concep- 
tion is very rare under these circumstances. 

At the menstrual period, the mouth of the womb is more 
open than at any other time ; is soft, and slightly swollen, 
with an increase of heat. The appearance of the menses is 
not, in this form of the disease, immediately followed with 
relief from pain, as it is in the next species to be described ; 
but the pain subsides gradually, alternating with pain in 
other parts, as the teeth, face, etc. The pulse during the 
attack is rather lowered than increased in strength; the 
patient has no fever, and is not apparently weakened by the 
attack. Each attack may last from twenty-four hours to 
four or five days ; after which time, the patient generally 
resumes her ordinary employments. 

We have seen cases, however, in which the patient's 
health during the interval was much more seriously affected, 
being liable to returns of severe headache or pains in the 
back, so intense, and so much aggravated by walking, as to 
oblige her to lie on the sofa, or remain almost constantly in 



PAINFUL MENSTRUATION. 847 

bed ; and, as the natural consequence of suffering and con- 
finement, the functions of the stomach and bowels became 
impaired, and the general health seriously injured. 

Causes. — The causes of painful menstruation are various : 
cold, sudden shocks, mental emotions, and any cause that 
will bring about an enfeebled condition of the system, may 
occasion the disease. 

The only mistake likely to be made is the confounding 
of one of these attacks with abortion, or miscarriage, on 
account of the paroxysms of pain and bearing down, and 
especially when the membrane already described is discharged 
entire. But if the case is one of disordered menstruation, 
we shall find that the patient has been regular. The blood 
will not clot, and has the odor of menstrual blood ; and if a 
membrane be discharged, it contains nothing but water ; and 
of course no foetus is detected. 

Treatment. — The indications of cure are two-fold : 

First, to mitigate the pain, and reduce the suffering during 
the attack ; and, 

Second, to prevent a return of the disease by appropriate 
remedies administered in the intervals. 

Our principal reliance for the first is to be placed in se- 
datives. When the pain in the back first commences, give 
five grains of Dover's powder, and repeat it every two hours 
until relief is obtained. Chloroform liniment should be 
applied to the back and abdomen, and the patient should 
sit over scalded bitter herbs : double tansy is best ; and 
when she lies down, the hot tansy should be rolled in a 
cloth and applied to the abdomen. I have seen almost im- 
mediate relief follow the use of this in very many cases. 
As soon as relief is obtained, give a dose of castor oil, with 
ten or fifteen drops of spirits of turpentine. 

The second indication. — During the intervals, every means 
should be made use of to strengthen the patient and to lessen 
the general and local irritability. To this end, the diet 
should be generous and nourishing, and free exercise should 
be taken in the open air once or twice daily. If the patient 
is not able to walk, she should ride on horseback or in an 
open carriage. For more than twenty years I have depended 
54 



848 MIDWIFERY. 

entirely upon the anodyne alterant as an internal remedy 
between the paroxysms of this disease ; it should be taken 
in sufficient quantity to keep up a regular condition of the 
bowels ; half a tablespoonful after each meal is usually suf- 
ficient. The patient should take the cold shower-bath, or 
sponge with cold water every morning between the terms ; 
but should discontinue it a few days before the term, and 
use the warm hip-bath every night until the discharge 
comes on. 

The second variety which we propose to notice is the 
inflammatory ', painful menstruation. 

This species differs materially from the one described, 
both in its symptoms and in its subjects. It occurs in fe- 
males of a full habit, of the sanguine temperament, and at 
an earlier age, and chiefly affects unmarried females. 

It generally comes on suddenly, and is caused by cold, 
or some violent constitutional disturbance. Young girls of 
a plethoric habit are liable to suffer slight symptoms of it 
at every catamenial visitation ; but marriage cures this form 
of the disease. 

In the milder form, there are but few precursory symp- 
toms ; but the more violent forms are preceded by restless- 
ness and rigors, with some fever, and flushing of the face, 
and general headache. For some time before the appearance 
of the oatanienia, the patient suffers with pain across the 
back, and an aching sensation in the limbs, weariness of the 
whole system, intolerance of light, etc. The face is flushed, 
the skin hot, the pulse full and strong, and upwards of one 
hundred beats in the minute. 

In some cages, the fever rises so high that delirium comes 
on; but when the flow takes place, all these symptoms 
subside. 

The time that elapses between the first appearance of the 
pain and the flow varies at different times and in different 
subjects ; but less, perhaps, than in the preceding form of 
this disease. 

The discharge in this form of the disease is more abun- 
dant, and is also occasionally accompanied with a membrane 
similar to that discharged in the first species. 



PAINFUL MENSTRUATION. 849 

During the intervals, the health of the patient is little 
affected. She sometimes has a slight pain in her head or 
side, and is often afflicted slightly with the whites between 
the periods, which is rarely the case in the former species. 

The severe symptoms may occur with every menstrual 
discharge ; but they are not so regular in their intensity as 
they are in the nervous form of this disease ; and occasion- 
ally a period will pass with but little suffering. 

If the neck of the uterus be examined during this time, 
it will be found more than usually full, with a considerable 
increase of heat in the parts ; but no tenderness will be felt 
on external pressure above the pubes. 

The breasts not unfrequently swell and become painful 
at this time, owing to the great sympathy between them and 
the uterus. A severe attack of this disease will disqualify 
the uterus for impregnation for some time afterwards ; but 
slight. attacks will not prevent conception; indeed, marriage 
is the best remedy. 

Treatment. — Mix a tablespoonful of soda with three of 
epsom salts, and give a teaspoonful three times a day during 
the week preceding the term. When the pains commence, 
add twenty grains of Dover's powder to an ounce of spirits 
of nitre, and give a teaspoonful every three hours in a cup 
of catnip or balm tea. 

The third or mechanical cause of painful menstruation or 
dyspmenorrhoea consists in a partial closure of the mouth of 
the womb, or of the vagina, caused by a thickening of its 
w T alls, or by the hymen being of unusual thickness, and 
such an imperfect aperture or opening as not to allow the 
menstrual secretion to pass off easily. 

The first, or contraction of the mouth of the womb, must 
be remedied by an application of the ointment of belladonna, 
or Jamestown weed, which will dispose it to dilate and 
lessen its sensibility. After this has been used a few days, 
a bougie may be passed through the mouth, and suffered to 
remain a short time. If one made of slippery-elm be used, 
it may be left in this situation all night, and by its expan- 
sion will complete the cure by a few applications. 

For an obstruction in the vagina, the same treatment is 



850 



MIDWIFERY. 



equally proper ; and the slippery-elm bougies may be in 
creased in size until the vaginal canal is distended to a 
sufficient amount. 

A partially imperforate hymen sometimes requires to be 
opened by making an incision through its substance. But 
even this may often be remedied by the above means. 

As an illustration of my mode of management in such 
cases, I will transfer a very interesting case which I had 
the honor of reporting to the Tennessee State Medical 
Society, and which was published, by its order, in the June 
number of the Nashville " Journal of Medicine and Surgery," 
1857. 

CASE OF UNRUPTURED HYMEN AFTER TWELVE YEARS' ENJOYMENT 
OF CONNUBIAL PRIVILEGES. 

Mrs. , about thirty-five years of age, of usually 

robust health, had been happily married over twelve years, 
but having failed to obtain pledges of love, consulted me as 
to the cause. Upon inquiry I ascertained that the cata- 
menia had always been regular as to recurrence, but con- 
tinued an unusual length of time, always becoming dark 
and foetid toward the termination, and, contrary to what is 
observed in dyspmenorrhoea, thei»e was no pain or constitu- 
tional disturbance at the commencement of the period, but 
these symptoms invariably supervened after a few days, 
becoming more intense toward the close, often extending 
through the second week, so that the pe v riod occupied near 
half the entire month. 

As these symptoms were rather peculiar, I judged there 
was an abnormal condition of the reproductive organs, and 
suggested a vaginal examination. To this she objected; 
but, after several unsuccessful efforts to correct the condi- 
tion of things, finally consented, when, to my surprise, I 
found the vagina terminated in a complete ad cle sac about 
two and a half inches from the vulva. As the walls felt 
perfectly smooth and elastic, giving no evidence of cicatri- 
zation, and she had never suffered vaginitis, and especially 
as she averred that the parts had always been in this con- 
dition, I felt assured that it was a case of Unruptured 



UNRUPTURED HYMEN. 851 

Hymen. As the catamenia had found a place of exit, I 
knew there must be an aperture, but for a long time was 
unable to detect it. The speculum showed a smooth, un- 
broken surface ; the tactus euriditus failed to detect any 
prominence or indentation which might indicate the point 
of connection between the divisions of the vagina. But 
after fully failing to discover where it probably was, I 
turned my attention to where it possibly might be ; and 
finally established its position about midway of the parietes 
of the vaginal sac, near an inch behind the meatus urinarius, 
just where I should at first have looked for it, but was 
misled by the hymen having been thrust upward until it 
apparently formed a part of the true vaginal walls. Into 
this opening I succeeded with some difficulty in introducing 
a small silver probe, which, having pass.ed the barrier, 
played quite freely within, showing that there was plenty 
of vagina above. 

This condition of things fully accounted for the symp- 
toms attending the menstrual period ■ for as the discharge 
found an exit with difficulty, it collected in the posterior 
part of the vaginal cavity above the septum, and was there 
retained until partial decomposition took place, giving rise 
to the pain, foetor, and nervous disturbance attending the 
latter part of the menstrual period. The first idea that 
suggested itself was to divide the septum; but as it had 
proved itself possessed of sufficient solidity to successfully 
resist the shocks incident to the wars of Venus for so long 
a period, I feared that its division might be attended with 
troublesome hemorrhage and constitutional disturbance. 
But feeling assured, by carefully watching the play of the 
probe, that the parietes were quite thin immediately below 
the aperture, I cautiously thrust a narrow bistoury by the 
side of the probe, turning the cutting edge from the bladder, 
making an aperture sufficient to permit the passage of a 
common-sized silver catheter. But although the cutting 
occasioned no pain, and was followed by inconsiderable 
hemorrhage, yet, as I was satisfied that the walls of the 
septum increased greatly in thickness immediately below 
the incision, I desisted for the present. A few days subse- 



852 MIDWIFERY. 

quently considerable cerebral disturbance came on, whethei 
from the incision, or from some other cause, I cannot say, 
but it made me fearful of again resorting to the knife, and 
I laid the case before my friend, Professor Bowling, who 
suggested that a trial be made to dilate the aperture by the 
use of slippery-elm bougies. As the plan appeared to be 
feasible, I immediately put it into practice, and with the 
most happy and entire success. 

Commencing with one of the size of a crow-quill, I daily 
replaced it with one slightly larger, until in a few weeks 
one of an inch and a quarter in diameter could be intro- 
duced with facility. Believing that this was sufficient for 
all present practical purposes, I concluded to trust to 
natural processes for further development, which proved to 
be quite adequate to the task. Although the menstrual 
function has since been performed with great facility, and 
without pain or nervous disturbance, and the uterus clear 
of disease, yet the main object of the operation has not yet 
been obtained, viz., fecundation. This may be owing to 
the fact that the os tincce had found a resting-place in the 
posterior portion of the sac, above the septum, and still 
remains embedded in such a way, that it does not corre- 
spond to the 'plane of the vagina, which error of position 
may probably yet be remedied. But though the maternal 
desire has not been gratified, the shortening of the cata- 
menial period, and the freedom from suffering which has 
been secured, amply compensate for the trifling inconveni- 
ence which attended the cure. 

WHITES LEUCORRHCEA. 

Much space has been occupied by authors in descriptions 
of this disease, and quite a difference of opinion prevails as 
to its nature, and from what portion of the uterus or vagina 
the discharge originates. I suppose the mucous membrane 
which lines the vagina and uterus is subject to the same 
laws of irritation as when found in other situations ; one 
of which is, that when excited to a certain degree, an 
increased secretion of natural mucus is thrown off; when 
more highly excited, this secretion becomes mixed with 



WHITES. 853 

plastic lymph, which gives it a denser consistence or 
greater tenacity. We find the first in connection with the 
mucous membrane of the bowels in mucous diarrhoea, and 
the second in dysentery. Then again, when the general 
system is debilitated and relaxed, and the mucous mem- 
brane in particular, a thin watery discharge is the conse- 
quence ; as in diarrhoea, in the last stage of consumption, 
low fevers, and of many other diseases which end in 
debility. It is, therefore, to be expected that the same 
circumstances would act in a like manner upon the mucous 
membrane of the .vagina and womb, and I deny that there 
are any causes for this disease but such as act upon the 
general principles which govern irritation and relaxation in 
other mucous membranes. This idea simplifies the subject 
exceedingly, for we have only to recollect the causes which 
produce the various kinds of deranged secretions in other 
parts having a mucous lining, to understand what will occa- 
sion a like effect upon that belonging to the genital organs. 
The only reason for referring these discharges to the womb, 
rather than to the vagina, is, as we stated w T hen treating of 
these organs, that the life force or general vital sensibility 
of the lining of the vagina is not near so great as that of 
the uterus ; and the latter is consequently much easier 
impressed by disturbing causes, and occasions, when irrita- 
tion is set up, much wider and graver sympathetic disturb- 
ance in other parts. 

The causes of leucorrhoea, therefore, naturally divide them- 
selves into such as act directly in getting up morbid excite- 
ment in the genital organs, or indirectly through vital con- 
nection or sympathy with other organs ; and such as 
produce debility and relaxation, either directly or indirectly. 
Of the first class, we may name cold ; excitement from late 
hours at dancing and other parties ; improper indulgence in 
food or drink, or in venery, etc. ; and a very frequent 
cause is a descent or prolapsus of the womb, which, in con- 
sequence of its pressure into the vagina, and being chafed 
by every motion of the body while lying upon the perineum, 
causes an irritation throughout its whole structure, which 
extends to its mucous lining; and, as this descent of the 



854 MIDWIFERY. 

womb is itself usually a consequence of congestion, brought 
about by the action of the above causes, it is to be expected 
that we should usually find prolapsus and leucorrhoea coex- 
isting : in fact, they are very rarely found separate. 

The second class of causes — those which produce debility 
and relaxation — are as numerous as the diseases and indul- 
gences which depress the system and exhaust its vital 
energies ; and it is unnecessary to particularize. 

Treatment. — The views set forth above as to the nature 
and causes of leucorrhoea divest the treatment of all mys- 
tery. If it be a case of excitement, which may be known 
by the heat and other febrile symptoms which attend it, 
and by the discharge being rather thick and adhesive, and 
not very profuse, or if thin, acrid and scalding, the proper 
course of treatment at once suggests itself, which is, cooling 
purgatives, tepid astringent hip-baths and injections, a sim- 
ple cooling diet, regular hours, quietness, etc. There is, 
however, one very efficient remedy, which would not so 
readily present itself, and that is balsam copaiva. This 
medicine, unfortunately, has in many localities obtained a 
bad name, in consequence of being so often associated by 
the physicians' prescriptions with an impure and odious dis- 
ease. But this frequent association occurs in consequence 
of the great power which the balsam possesses over irrita- 
tion and inflammation of the mucous membranes in general, 
and not because of any specific action in gonorrhoeal in- 
flammation. When practicing in regions where this vile 
disease was unknown, balsam copaiva constituted my surest 
reliance in irritations of the mucous membrane, whether 
that be in the mouth, constituting aphtha or thrush ; the 
throat, in the form of bronchitis ; in the lungs, in deep-seated 
colds and coughs ; in the bowels, producing chronic diarrhoea ; 
the kidneys and bladder, in painful micturition ; or in the 
vagina and uterus, in leucorrhoea or whites. 

The best form of administering the balsam is the follow- 
ing: Balsam copaiva, half an ounce; sweet spirits of nitre, 
two ounces ; spirits of lavender compound, half an ounce ; 
and simple syrup, three ounces. Mix, and give a teaspoon- 
ful from three to five times a day. 



FALLING OF THE WOMB. 855 

For the second variety, the treatment will consist in re- 
moving the disease or state of the system which has brought 
about this local weakness. The indication, therefore, is to 
restore general health and vigor, and this affliction will then 
disappear. But, as in debilitating and wasting discharges 
from the bowels, skin, or kidneys, this drain from the system 
is often sufficient to counteract all our well-meant efforts at 
a restoration of the general health, and must be checked 
before we can succeed. It becomes necessary, therefore, to 
do something for the disease itself. And as general weak- 
ness is almost always accompanied with increased nervous 
sensibility, it becomes necessary to combine with other 
means something that will allay nervous irritation, which, 
indeed, in these cases often constitute the most prominent 
symptoms. In combining remedies, it will be best, there- 
fore, to unite those possessing tonic, astringent, and anodyne 
properties. The following pill will generally be found as good 
as any : Assafcetida, gum myrrh, and burnt copperas, each 
forty grains ; make twenty-five pills, and give one three times 
a day. Injections containing the same general projDerties 
should also be daily made into the vagina. The following 
is as good as any : Yellow puccoon and nut-galls, each one 
ounce ; sulphate of zinc, half an ounce ; opium, one drachm ; 
infuse in two quarts of hot water, and decant and bottle. 
A gill of this should be injected two or three times a day. 

PROLAPSUS UTERI, OR FALLING OF THE WOMB. 

By prolapsus is understood a descent of the womb below 
the position in the pelvis which it naturally occupies. 
When this descent only brings the uterus sufficiently low 
as to allow the cervix, or neck, to rest upon the perineum, 
or against the vulva, it is said to be incomplete ; when it 
descends through the vulva, and becomes external, it is 
called complete prolapsus. The uterus now hangs down at 
the labia, between which and this body there is no interspace 
into which the finger or probe can be introduced. This 
cannot happen without the bladder and rectum being con- 
siderably deranged in regard to position. The first is always 
drawn backward, so as to take the natural situation of the 



856 MIDWIFERY. 

uterus, and assume, as well as the meatus urinarius, a hori- 
zontal position. Hence, we see in what direction a catheter 
should generally be introduced in these cases. 

As the return of blood from the prolapsed uterus is usually 
more or less obstructed, the part frequently becomes very 
much swollen, and even copious discharges of blood occur. 
The naturally delicate texture of the lining of the vagina 
undergoes such an alteration that it seems more like the 
structure of the common integuments. 

The friction of the clothes on the swelling, however, 
mostly occasions very painful ulceration on the outside of 
the vagina, if the prolapsus should be recent. But when 
the parts have been long down, they adapt themselves to 
their new situation, and hence we see an old "neglected pro- 
lapsus attended with no particular occurrences, except the 
descent of the tumor when the patient is erect, and its re- 
turn when she is in a recumbent posture. 

Polypus is the only disease with which the prolapsus uteri 
can be confounded ; and the mode of discrimination must be 
learned by referring to the chapter on that subject. 

The causes of the prolapsus uteri are such as either relax 
the parts retaining the uterus in its natural position, or such 
as force this organ downward. Women who have had many 
children are particularly subject to the complaint. The 
prolapsus is also very liable to occur soon after delivery, 
when all the parts of generation are dilated and relaxed. 

There are two indications in the treatment, viz. : to reduce 
the uterus into its natural position, and to prevent its de- 
scending again. The first object is in general very easy of 
accomplishment, when the prolapsus is incomplete. The 
second is effected by making the patient wear a pessary in 
the vagina, and use astringent injections. Incomparably, 
the most suitable pessary is one made of the bark of the 
slippery-elm, of which we will speak more at large hereafter. 

The reduction of a complete prolapsus of long standing 
is sometimes difficult. The operation should be done before 
the patient gets out of bed in the morning. It is sometimes 
of use to empty the large intestines by a clyster before 
attempting reduction. However, the thickening of the pro- 



INVERSION OF THE UTERUS. 857 

lapsed viscus, and the alteration made in the position of the 
surrounding parts, in some instances render the design quite 
impracticable. In this circumstance, we must be content 
with drawing off the urine with a catheter if requisite, and 
supporting the part with a bandage. 

The presence of ulcerations is no reason for not attempt- 
ing to reduce the displaced part. When the tumor is very 
much inflamed and swollen, it is sometimes advisable to 
defer the attempt to replace the uterus until bleeding, the 
application of cold washes, etc., have diminished its size. 

In recent cases of prolapsus uteri, we may hope to effect 
a radical cure by bringing the relaxed and dilated parts into 
another state. This may be accomplished by introducing 
into the vagina,, immediately after the uterus has been re- 
duced, a slippery-elm pessary ; and for a time the T bandage 
is also to be worn, and the patient should remain for a day 
or two in a horizontal posture, and carefully avoid all strong 
efforts in going to stool, making water, etc. 

INVERSION OF THE UTERUS. 

Sometimes the uterus descends through its own mouth 
into the vagina, and occasionally quite out of the vulva. 
The first is the incomplete, the second the complete inversio 
uteri. In the latter, the vagina is also drawn down and 
inverted, so that the whole tumor situated before the parts 
of generation seems to hang by a pedicle, formed of the 
inverted vagina. Between this pedicle and the labia there 
is no interspace into which a probe can be passed. The 
outer surface of the tumor is, in fact, the inner lining of the 
uterus. 

As the fundus uteri evidently cannot descend through 
the os uteri unless this aperture be very much dilated, it is 
obvious that the inversio uteri can rarely occur except 
immediately after delivery. An unskilful employment of 
force in extracting the placenta is a very common occasion 
of the accident. Polypi growing from the fundus uteri are, 
however, particular cases, in which the inversion of this 
organ may occur from its being dragged downward by the 
weight of these tumors. 



858 MIDWIFERY. 

Great pain, inflammation, tumefaction, and hemorrhage, 
usually follow the inversio uteri. Even mortification, con- 
vulsions, and death may take place, in consequence of the 
complete stage of the disorder, particularly when it has 
occurred in a very sudden manner. 

The reduction of the inverted uterus ought not to be 
delayed a moment. The longer the operation is deferred, 
the more difficult it becomes ; for, in general, pain, inflam- . 
mation, and swelling come on with great rapidity. When 
inflammation has alreadv occurred, leeches and fomentations 
should be applied to the tumor, and the reduction be after- 
wards attempted. 

In very old cases, in which the fundus uteri has suffered 
long compressions in the vagina, the viscus becomes altered 
in its structure and figure so much that the inversion is 
totally incurable. The further descent of the viscus can 
only be prevented by the employment of a pessary. 

ANTROVERSION AND RETROVERSION. 

The uterus may either be turned forward or backward ; 
the last is the most common, and is named retroversio. In 
the first case the fundus uteri becomes situated towards the 
os puhes, over the fundus of the bladder ; while the os uteri 
is inclined towards the sacrum and middle part of the 
rectum, and is often situated so high up that it can hardly 
be reached by the finger. 

The patient generally experiences a constant inclination 
to make water ; feels pain whenever pressure is made above 
the os pubis ; and, on standing up, perceives a hard body 
fall on the bladder, compelling her to empty this receptacle ; 
but the tumor regularly falls backward again when she lies 
on her back. 

This case is usually easily relieved. The practitioner 
should place the patient on her back, and make pressure 
with his hand just over the os pubis. At the same time a 
finger introduced to the upper part of" the vagina is to press 
it forward, so as to urge the os uteri forward, while the 
pressure of the other hand is tending to push backward the 
fundus. The recurrence of the accident is to be prevented 



ANTROVERSION AND RETROVERSION. 859 

by keeping the patient on her back, and applying a com- 
press and bandage to the abdomen just above the pubes. 
In rare cases, the fundes of the womb becomes wedged, as 
it were, between the bladder and the vagina, and is ex- 
tremely difficult to dislodge ; a physician of much skill will 
be required in this case. 

In the true retroversion the os uteri is inclined towards the 
pubes, while its fundus is approximated to the sacrum, and 
descends so far between the rectum and vagina that it occa- 
sions a tumor at the posterior side of the latter tube. The 
viscus, thus situated, may render the passage of the faeces 
exceedingly difficult, and even impossible. As the preter- 
natural position of the uterus necessarily displaces the 
bladder and urethra, retention of urine always attends the 
case ; and this is the more troublesome, as the catheter, in 
such circumstances, cannot be very easily introduced. The 
orifice of the urethra is so drawn upward that it is some- 
times situated higher than the arch of the pubes. When 
the bladder is very much distended, it prevents the os uteri 
from being felt with the finger. The retroversio uteri com- 
monly happens during the second, third, or fourth month 
of pregnancy. In the latter months the uterus is too 
bulky to become situated between the vagina and rectum. 

The retroverted uterus should always be replaced, as 
soon as possible, in its natural situation. The longer the 
case has lasted, the more difficult it is to rectify it, and the 
more the danger of the occurrence increases. The greatest 
urgency arises from the retention of urine and impediment 
to the passage of the faeces. The distention of the bladder 
and rectum must naturally render the reduction of the 
uterus more difficult. Sometimes abortion takes place, and 
this event has occasionally been known to be productive of 
relief. 

As the return of the uterus to its natural position is 
always greatly facilitated by drawing off the urine with a 
catheter, this operation should be first performed. The 
uterus has often been known to resume its proper situation 
on the bladder being emptied. So much difficulty has 
sometimes been experienced in introducing a catheter in 



860 MIDWIFERY. 

these cases, that some practitioners have been obliged to 
puncture the bladder. However, few who know the way 
in which the urethra is displaced by a retroversio uteri 
would find such a proceeding necessary. The rectum 
should also be emptied, if possible, by clysters. 

Reduction is accomplished by making pressure on the 
fundus uteri, with two fingers introduced into the rectum. 
The chief impediment to success arises from the projection 
of the sacrum. Hence the pressure should be so directed 
as to avoid forcing the uterus against this part. The opera- 
tion should be accomplished while the patient is kneeling 
and leaning on her elbows, for in this position the uterus 
becomes more distant from the sacrum. The fundus uteri 
should be pushed upward and forward, toward the navel. 
Sometimes it is preferable to make pressure with the fingers 
in the vagina. 

As I have never had an opportunity of using the slippery- 
elm pessary for this disease, no case having occurred in my 
practice since I invented the instrument, I cannot speak 
from experience, but I should confidently expect that a 
large one introduced as far back into the vagina as possible, 
and in contact with the fundus of the womb, would by its 
gradual expansion, which might be hastened by frequent 
tepid injections, gradually push the fundus up, and bring 
the organ into a right position. 

IRRITATION AND ULCERATION OF THE WOMB. 

Of late years, since the use of the speculum became com- 
mon, ulceration of the womb has become a rather fashion- 
able disease. That there does occasionally occur a case of 
real ulceration of the tissues about the neck, and even 
within the womb, I readily admit, as in a practice of 
upwards of thirty years I have met in my own experience 
three such cases ; but the disease now so common, and 
which has been dignified by late authors with the term 
ulceration of the womb, does not merit that grave appella- 
tion, as it consists in nothing more than a slight blistering 
or abrasion of the delicate epithelium, which answers to 
the mucous membrane what the scarf-skin does to the 



IRRITATION AND ULCERATION OF THE WOMB. 861 

external surface. Now every wormy child will give ex- 
amples of the same form of disease in the form of blisters 
and excoriations about the mouth, nose, and anus. In fact. 
it is a law appertaining to the mucous membrane that an 
irritation, existing at any point of its surface, will manifest 
itself by this kind of outcropping at its external opening — 
a wise provision by which we can read or understand, by 
the part seen, the situation of parts out of sight. Now 
when the mucous lining of the womb has become the sub- 
ject of irritation, this same outcropping may always be 
found upon the lips of the mouth of the uterus ; but it no 
more constitutes the disease than the excoriations of the 
anus do that of the worm case in the child. What has 
served to deceive both the physician and the patient with 
reference to this subject, is that cauterizing these blisters or 
abrasions almost uniformly gives temporary relief. This 
occurs from two causes : it at once allays the burning or 
aching sensation which is due to the local manifestation, 
and the strong impression made upon this part of the 
womb (and also on the patient's mind) serves for a time 
to break up the morbid chain of nervous influence, which 
often has much to do in getting up and continuing the dis- 
ease. But notwithstanding the ulcers, as they are called, 
disappear after being touched with nitrate of silver, and 
the patient's sufferings for a time are suspended, and her 
hopes wonderfully elated, and the operator looked upon as 
a wonderful man of science, an especial saviour, yet, alas, 
the blisters come again, again are cauterized, and this is 
repeated until the patient's confidence is gradually frittered 
away until she finally sinks into hopeless despondency, or 
seeks relief from quacks and nostrums, regarding medical 
science as a humbug, and bringing discredit upon a noble 
profession. 

True medical science will look upon these ulcers as a 
mere symptom of irritation of the mucous lining of the 
womb, or, perhaps, of the entire substance of the organ. 
And science further teaches that the womb, in consequence 
of congestion occasioned by this irritation, often becomes 
too heavy to be adequately supported by the relaxed uterine 



862 MIDWIFERY. 

attachments, and a falling or descent takes place, which fur- 
ther aggravates the case by the unnatural position, and the 
rubbing of the cervix uteri against the rough folds of the 
vagina, and the unyielding perineum. 

This disease should therefore be treated upon general 
principles : whatever disturbing causes have served to 
get up and continue the irritation should be removed or 
avoided — such as irregular living, costiveness, irregular and 
excessive exercise, as dancing, excessive venery, etc. At 
the same time, all those measures which have a tendency 
to equalize excitement and improve the general health should 
be attended to, as the observance of prudence and regularity 
in eating, sleeping, exercise, etc. ; to which should be added 
the cold bath or ablutions, cheerful company, or light and 
useful employments which admit of moderate exercise, 
horse exercise, etc. For more specific directions as to diet, 
regimen, and medicine, see Dyspepsia, Scrofula, and Chlo- 
rosis. 

Much advantage may also be obtained from local mea- 
sures ; and when used with the idea of a palliative, and an 
assistant to the general treatment, the application of nitrate 
of silver to the abrasions about the cervix uteri becomes 
eminently a sensible and useful remedy. Astringent washes 
or injections, such as were recommended in leucorrhcea, or 
whites, are also of great advantage. 

But since I adopted the use of the slippery-elm pes- 
sary I have had no occasion for the employment of any 
other means, either for reducing the irritation, which gives 
rise to the blistering, or for removing the congestion and 
general feverish condition of the womb, which always at- 
tends the disease, and occasions its increased size and den- 
sity, which, by making it heavier, becomes the chief cause 
of its descent ; which, as we have said, in its turn becomes 
a cause of further irritation — is, in fact, the principal cause, 
when this affliction occurs in the early months of pregnancy. 
And the elm pessary, as we have already said, is also by 
far the best means ever yet devised for removing the pro- 
lapsus. The profession had long felt the want of just such 
an instrument. Chomal, a celebrated French author, ex- 



IRRITATION AND ULCERATION OF THE WOMB. 863 

presses his regret that some means could not be devised 
which, while supporting the womb, would also act medicin- 
ally in soothing its irritability. All other pessaries or ap- 
pliances for holding up the womb, so far from doing this, 
have almost uniformly been found to become themselves 
sources of irritation ; and hence, many authors wholly repu- 
diate their use. But this, while it gives mechanical support, 
also acts upon the swollen, irritable, and perhaps ulcerated 
womb just as a slippery-elm poultice does upon a like con- 
dition of the tissues externally. A great majority of the 
cases of irritation and prolapsus of the womb, connected 
with pregnancy, as well as many others, may be relieved 
by this instrument, without the aid of any other measures. 
Perhaps I cannot do better than transfer some extracts 
from a paper which I prepared upon the subject of medi- 
cinal preparations made of the bark of the slippery-elm, at 
the request of the State Medical Society, and read before 
that body at its last session. The other subjects contained 
in that paper will be referred to in their proper place, and 
the method of preparing the pessary, and other preparations, 
will be found under the head of Slippery-Elm, in the Mate- 
ria Medica, at the latter part of this work. 

It is hardly necessary for me to offer any explanation of 
the modus operandi of the above medicated pessary in the 
cure of many female afflictions, or to give evidence of its 
usefulness, as both will be perceived in a moment by every 
one at all acquainted with the materials used, and the mala- 
dies in which the pessary is indicated. But this pessary is 
of advantage in a variety of cases in which other pessaries 
would not only do no good, but produce positive injury. I 
have concluded, therefore, to give a hasty sketch of the va- 
rious ills for which I have used it with advantage : 

Case 1. — Soon after having made the first slippery-elm 
pessary, I was called to see a lady who was suffering from 
retention of urine, an affliction from which she had suffered 
much during the early months of two former pregnancies — 
her physician having to visit her daily for weeks, and use 
the catheter ; but as he could not be found on the present 
55 



8Q£ MIDWIFERY. 

occasion, I was called in. Now it occurred to me that my 
pessary was the very article indicated in this case ; and. 
after giving present relief by the catheter, I introduced one, 
and informed her that it would probably relieve her from 
any further annoyance, which proved to be so. 

Case 2. — Soon after this I was called to see a colored 
woman at Mr. Wm. Boyd's who had fallen down stairs, she 
being in the seventh month of pregnancy. Manifest symp- 
toms of miscarriage soon occurred, attended with great 
soreness and tenderness of the abdomen. I ordered a poul- 
tice to the belly, and introduced a medicated pessary; in 
a few hours the urgent symptoms all subsided, and she was 
up the next day. But about a week subsequently, I was 
hastily sent for, and she informed me that she had miscar- 
ried, but that it was no child — she passed it too, she said, 
without pain ; upon examination, I found it to consist of the 
pessary I had introduced, greatly enlarged; she had not 
been aware that I had introduced it at all. She afterward 
brought forth a fine child at the full time, and did well. 

Case 3. — A short time after this I was called to at- 
tend a woman who had just made a long and tiresome 
journey on the cars without stopping; her courses being on 
her, and the nights cold, suppression was the consequence, 
attended with great pain, acute tenderness, and considerable 
tumefaction of the whole abdomen, and high symptomatic 
fever. I gave her a purgative of .castor oil and turpentine, 
ordered fomentations to the belly, and introduced a medi- 
cated pessary. General relief followed very speedily. 

Case 4. — A lady who had suffered much for a number of 
years with neuralgic affections and bronchitis, and who had 
had several premature deliveries, in consequence of the un- 
controllable cough and nervous pains, always increased by 
reflex uterine sympathies ; was now in her eighth month, 
and imminently threatened with miscarriage from the above 
causes. As she had been under the .direction of several 
skilful physicians, who had exhausted all the usual reme- 
dies, I resolved to try the power of the soothing and ano- 
dyne properties of the medicated pessary, supposing that, 



IRRITATION AND ULCERATION OF THE WOMB. 865 

as the lungs were pathologically sympathizing with the 
womb, I could make them do so curatively. It acted be- 
yond my expectations, giving complete relief. 

Case 5. — Kitty, cook at Captain Walton's. Had dysp- 
menorrhoea; had been married for a number of years, 
but remained barren; her health continuing to decline 
until she was incapable of attending to business; had 
fits at each menstrual period. Found the womb as large as 
in the third month of pregnancy, feehng as hard as a ball 
of wood, and very heavy ; great tenderness of the cervix, 
which was of a deep mahogany color, with some epithe- 
lian abrasions, profuse flocculent discharge, etc. 

Introduced the medicated pessary, and put her upon sar- 
saparilla and iodide of potassium ; introduced a fresh pessa- 
ry every week, until three had been used. The uterus had 
now become soft and of natural size, tenderness all gone, 
general health much improved ; had remained pretty clear 
of suffering, and has had no fits for over six months ; at- 
tends to business as other negroes ; had one spell of suffer- 
ing since, which was soon relieved by the use of the pessary. 
In this case there was not much prolapsus. 

Case 6. — A seamstress at J. B. White's. Had suf- 
fered with ulceration and prolapsus of the womb many 
years ; had been frequently treated by different physicians, 
with only temporary benefit. She came under my care 
about eight months since. I examined with the speculum, 
and found the womb very low — much enlarged, and consid- 
erable abrasions ; she was generally dropsical ; feet and legs 
much swollen. I used the pessary, and put her upon sar- 
saparilla and potassium, as in the fourth case. Her general 
health improved rapidly, and there has not been much com- 
plaint of the womb disease since, except on one occasion, 
when she had very imprudently exposed herself, and was 
suffering great pain in the back and abdomen, simulating 
labor-pains : the pessary gave her prompt relief. 

Case 7. — Clara, a servant of William 0. Harris, of this 
city. Had sent her to the State Hospital for treatment 
nearly three years ago, where she remained about two years ; 
during this time, I examined her several times, at the re- 



866 MIDWIFEKY. 

quest of the superintendent, Dr. Wharton ; her womb was 
very low, and greatly enlarged, quite hard, and adherent to 
the vaginal walls ; cervix nodulated, and frequently exten- 
sively ulcerated ; most of the time suffered great torture, 
so that full doses of opiates had to be resorted to, to give 
partial relief; was fully treated, according to Bennet, with 
leeches, scarificator, caustics, etc. Her disease would at 
times apparently yield, but about the time she would be 
thought ready to leave the hospital, would suddenly return 
with renewed force. When Dr. Wharton left the hospital, 
he said to me that he did not know what would become of 
Clara, as she had been already a great expense to her kind 
friends, and was not yet fit to be removed from the imme- 
diate eye of a physician. I suggested that, if Mr. Harris 
were willing, I would take her to my house and attend her 
there ; he saw Mr. Harris, and the arrangement was made. 
I immediately used the medicated pessary, and nothing else, 
except an anodyne at' her monthly period ; she soon im- 
proved so as to become useful, and has, for the last several 
months, done the entire duties of our kitchen. I used per- 
haps half a dozen pessaries in her treatment ; she still com- 
plains, at times, of erratic pains, but her general health is 
good ; the womb is still rather low, having formed adhesions 
to the walls of the vagina, but has become accustomed to 
its position, and tolerates it. 

Such cases could be detailed unto weariness, that have 
yielded to this remedy, but it is not necessary : a mere sug- 
gestion of the instrument, also suggests to the mind of the 
intelligent physician its advantages. It is the very thing 
we wanted, a means that will hold the womb in place, and 
at the same time subdue irritation, remove hardness, allay 
fever, and promote the healing of ulcers. 

A few words perhaps should be said as to my motives 
for selecting the particular articles which compose my medi- 
cated pessary. The slippery-elm is the base, and without it 
the thing could not be made at all ; but without the sassa- 
fras, the pessary would be a nuisance. A few hours' con- 
finement in an inflamed vagina, and absorbing its hot, vitiated 
secretions, will cause such a decomposition as to convert it 



IRRITATION AND ULCERATION OF THE WOMB. 867 

into an irritating foetid mass ; but the sassafras prevents 
this ; it effectually stays decomposition, and removes foetor 
if already present. I distinctly stated this property of 
sassafras when treating on dysentery, published in the 
Nashville Medical Journal in 1853, and transferred to this 
book. 

The balsam copaiva is added to the pessary because of 
its known power over inflammation of the mucous membrane. 
Its action in gonorrhoea is believed not to be specific, but 
general; and it has been reported, by good authority, to 
cure when applied locally, by injection alone. I have long 
used it as one of the best means in bronchitis and chronic 
dysentery, and have lately apparently cured several cases 
of gonorrhoea in the female, with no other means but the 
medicated pessary and injections of tepid water. The 
Dover's powder is introduced for the purpose of relieving 
present sufferings, but it acts not merely as an opiate — it 
possesses other powers as a topical as well as an internal 
remedy. 

As regards the application of the pessar^y, there is but 
little skill required ; patients, with a little instruction, will 
do that themselves. It is only to be remembered, that it 
must be dipped in water immediate!?/ before insertion — a few 
minutes' delay will make it tenacious, and of difficult intro- 
duction ; the cup-side must be applied to the os uteri, and 
the woman directed to remain in a recumbent position fifteen 
or twenty minutes ; by that time the pessary has adjusted 
itself to the uterus, so as to adhere with considerable force, 
and there will be no danger of its displacement, even should 
it be very small, and the vagina morbidly dilated. On this 
account I find it unnecessary to vary the size to suit the 
capacity, as with other pessaries. It is best, in all cases, 
to let the pessary remain until it begins to disintegrate. 
If there is abundant secretion, this will take place in a few 
days ; if there is great dryness of the vagina, it is best to 
use tepid injections occasionally, so as to make the pessary 
act as a poultice. 



868 MIDWIFERY. 



CHAPTER III. 

DISEASES PECULIAR TO PREGNANCY. 

As most of the diseases usually treated of in connection 
with pregnancy have already been considered, they will not 
again be taken up ; but the reader is referred to the various 
heads under which they occur ; as, Peritonitis, or Puerperal 
Fever ; Phlegmasia Dolens, or Milk-leg ; Convulsions ; 
Cramp ; Costiveness ; Flatulence ; Acidity ; Suppression of 
Urine, etc. There only remains miscarriage, or abortion, 
yet to be treated of. 

By the term abortion is usually understood a loss of the 
embryo, or product of conception, before the period of quick- 
ening ; and by miscarriage, a like accident occurring after 
quickening and before the full period of utero-gestation has ex- 
pired. These misfortunes are the result of various causes ; such 
as falls, violent exercise, frights, and other sudden mental 
emotions ; severe sickness, or any other powerfully disturb- 
ing circumstance. It is perhaps at times the result of an 
insufficient life-force in the embryo, or an irritable condition 
of the womb, which will not tolerate the presence of the 
new growth ; and, at a later period, miscarriage is undoubt- 
edly often occasioned by an indisposition of the uterus to 
further expansion in correspondence with the growth of the 
foetus. But from whatever cause the accident occurs, it is 
more likely to take place at about the same period in sub- 
sequent pregnancies, which makes it very important to 
guard against the first, and especially a second misfortune 
of this kind. The means of prevention are of course as 
various as the causes of the accident, and mainly consist in 



DISEASES PECULIAR TO PREGNANCY. 869 

avoiding them, or guarding against their influence. There 
are, however, certain indications which present themselves 
for our especial attention in almost all cases : such as pre- 
serving a regular and quiet condition of the bowels ; the 
preservation of the general health ; and especially to keep 
down morbid excitability in the uterus, and thus guard 
against its becoming, as it were, restive under the task im- 
posed upon it, and rebelling against further distention. 
The proper means for removing the various general disturb- 
ances have been fully given under other heads in this work ; 
only those which apply to the peculiar condition of the 
womb itself need now to be referred to ; and these are 
principally such as obviate or remove excessive irritability 
or rigidity of this organ. The whole list of anodynes and 
antispasmodics are applicable, and have been resorted to for 
subduing uterine irritability, such as musk, castor, assa- 
foetida, hops, dulcamara, etc. ; and for relieving rigidity of 
the uterine fibre, the warm or tepid bath, fomentations, oily 
embrocations, and nauseants, are chiefly relied on. 

As the author's manner of preventing these accidents, 
and also of relieving many other minor afflictions connected 
with the pregnant condition, are embodied in a paper which 
he read before the Davidson County Medical Society in 
1853, and published by its order in the Nashville Journal 
of Medicine and Surgery, it will be transferred entire. 

ON THE USE OF THE EXTRACT OF HYOSCYAMUS AND OIL OF 
SASSAFRAS IN SOME OF THE MISFORTUNES ATTENDANT ON 
PREGNANCY. 

I have selected the above as the subject of my paper 
because I imagine I can offer upon it something that is 
new, and, what is of more importance, useful in practice. 

Very shortly after commencing the practice of medicine, 
by a favorable state of circumstances, I got introduced into 
a pretty extensive practice of midwifery ; and was soon 
led to regret the want of more efficient means for relieving 
many of the ills which are often associated with the preg- 
nant condition than the medical science at that time fur- 
nished. Opiates, it is true, afforded alleviation ; but gene- 



870 



MIDWIFERY. 



rally at the expense of some other form of suffering 01 
disadvantage, such as checking the natural secretions, dis- 
turbance of the head, etc. On one occasion, while waiting 
upon a tedious case of labor, I amused myself, along with 
the matrons present, in the enjoyment of the pipe rather 
freely, and suffered a good deal of vertigo as a consequence. 
In the course of the conversation which this incident gave 
rise to, one of the company observed that the dry bark of 
sassafras, combined with tobacco, would effectually prevent 
its unpleasant effects upon the head. I laid this up in my 
mind, and on the first opportunity made the experiment, 
and found it eminently true ; the sassafras not only pre- 
venting the injurious effects of tobacco, but speedily remov- 
ing them when produced. I tested this repeatedly, by 
smoking in a strong pipe until my head was very disagree- 
ably impressed, and then reloading with a mixture of 
sassafras bark; a few puffs of which invariably dispelled 
all unpleasant sensations. I had now satisfied myself that 
sassafras was an anti-narcotic, so far as tobacco was con- 
cerned, and resolved to test its powers upon some other 
narcotic stimulants, and first selected the hyoscyamus. I 
added a drop of oil of sassafras to every two grains of 
extract of hyoscyamus, and made it into pills by the assist- 
ance of flour, and tested it first upon myself. Being very 
susceptible to the influence of nervous stimulants, I began 
by taking one common-sized pill, and increased the dose 
until I took five at once, without producing any other effect 
than a most delightful sleep — such as I had not enjoyed 
since, when a child, I used to fall down under the shade of 
a tree when tired at play. I now believed I had obtained 
the desideratum for which I had been wishing ; and expe- 
rience fully verified my anticipations. It acted like a 
charm in soothing the excited nerves, and saved my partu- 
rient patients of nearly all suffering, except the necessary 
throes of labor. For some time I was uncertain whether 
the narcotic property of the henbane was wholly counter- 
acted, or only lessened by the sassafras ; but a mischievous 
little girl solved this question for me. Her mother being 
pregnant, and suffering much from costiveness and erratic 



DISEASES PECULIAR TO PREGNANCY. 871 

pains, I made a syrup of butternut, to which I added sixty 
grains of hyoscyamus and thirty drops of oil of sassafras 
to the half pint, and directed a tablespoonful to be taken 
often enough to keep her comfortable. Her little daughter, 
seeing her take it frequently, supposed it was, of course, 
something good, and, in the absence of the rest of the 
family, managed to get hold of the bottle, and finding it 
sweet, drank all that remained, which was over a gill, and 
contained at least thirty grains of hyoscyamus. Her 
mother was at first frightened, and sent to the field for a 
boy to go after me, but, seeing no immediate unpleasant 
effects from the medicine, concluded to wait a while. The 
child, after a little, got into a crib and fell asleep, and slept 
quietly and naturally for about three hours, when the 
cathartic effects of the butternut aroused her. No inju- 
rious effects followed. I was now fully convinced that the 
sassafras rendered the hyoscyamus entirely innocent, and 
have ever since given it in just such quantity as to secure 
an immunity from suffering. I never pushed it to the 
extent that the child did but on one occasion. In 1835, 
when the cholera was prevailing so fatally on Round Lick 
Creek, in Smith county, while at Mrs. Hearn's, where there 
were two corpses in the house, and one in the kitchen, and 
several more in a dying condition, a stout negro man, while 
walking across the yard with a spade on his shoulder 
intended to be used in preparing graves, was attacked with 
such violent cramps as to cause him to scream out. The 
spasm was of the tonic kind, making his lower extremities 
and body as rigid as if frozen. I happened to have a 
bottle of the above syrup in my pocket, which I had pre- 
pared for a lady who had been confined the previous even- 
ing, and whom I intended visiting in m}^ round, and imme- 
diately gave him about four ounces, containing at least forty 
grains of hyoscyamus. In a few minutes the spasm 
relaxed, and he assisted all day in burying the dead. I 
do not give this as a case of cholera ; I did not consider it 
as such; and yet it doubtless was produced by the joint 
influence of cholera and fear. I did give it, though, in 
genuine cases of cholera, and always with the effect of 



872 MIDWIFERY. 

relieving the spasm, provided the stomach retained it a few 
minutes ; but, unfortunately, it was often rejected before ii 
had time to produce any impression. 

Having ascertained the controlling power which the 
remedy was capable of exerting over many forms of disease 
arising from morbid innervation, and looking upon most 
cases of abortion and premature labor as originating from 
that cause, I expected it to prove valuable in their treat- 
ment, and was not disappointed when I brought it to the 
test of experience. I have now used it in all cases of this 
kind happening in a pretty large practice for about twenty- 
five years, having more calls than usual in the same amount 
of general practice, my success having given me some 
notoriety in that line ; and I recollect of no case of failure, 
where I was called in previous to the occurrence of con- 
siderable expulsive uterine contraction. But as cases are 
more impressive than mere general observations, I will, in 
a very concise manner, give a few of the most prominent 
which have been treated with this remedy. 

Case 1. — 1835, Smith county, Pharabee, colored, aged 
thirty. Commenced bearing children at fifteen; had five 
in quick succession, after which she aborted five times 
between the sixth and seventh month. Commenced giv- 
ing the medicine — namely, the hyoscyamus and sassa- 
fras — at the middle of the sixth month, and continued 
it six weeks. She went to the full period, but had a 
dead child, after which she had four living children. 

Case 2. — 1840, S. Berdine's seamstress, aged thirty- 
five. Had two children when very young, and had aborted 
nearly every year since, between the third and fourth 
month. Commenced giving the medicine as soon as she 
was known to be pregnant, and gave it until the period of 
quickening. She went her full time ; had a fine living 
child. A year after, again became pregnant ; gave the 
medicine with the same result, after which she ceased 
breeding. 

Case 3. — 1843, Mrs. S . Married at fifteen ; had two 

living children, then three miscarriages in succession about 
the sixth month. Commenced the medicine a while before 



DISEASES PECULIAR TO PREGNANCY. 873 

the catastrophe was expected ; continued it four weeks ; 
did well, and continued afterward to bear living children. 

Case 4. — 1845, Mrs. D , Wilson county. Married 

young; had a living child, which died; after which she 
aborted every year for seven or eight, about the third 
month. Commenced the medicine as soon as pregnancy 
was known, and continued until after quickening; had a 
fine child at the full time ; three years after, had another ; 
both still living. 

Case 5. — Mrs. C . Married at fourteen; had two 

children ; after which she had severe flooding about every 
six months for four or five years. She did not consider 
them abortions ; said they came on a week or two after she 
ought to have been unwell. I requested her, in case of 
another attack, to save all that passed until I could be sent 
for, which she did. It presented the appearance of blood 
only, but upon putting it into a vessel of water, I disco- 
vered something like an organized mass, and placing this in 
a fresh basin of water, I had presented the finest specimen 
of an embryo I ever saw. It was about the size of the 
chick on the eighth or ninth day of incubation, and very 
much resembled one. There was an umbilical cord of about 
two inches in length and the size of a wheat straw, and a 
placenta, perhaps two and a half inches across the disc, 
presenting on the maternal surface a most beautiful floccu- 
lent appearance while floating in the water. Gestation in 
this case could not have existed more thari thirty-five days. 
I gave her a supply of the medicine, and directed her to 
commence taking it immediately after missing a menstrual 
period. She did so, and next year had a living child. 

Case 6. — Thomas Edwards's house servant, aged about 
twenty-five. Bore children quite young, and had mis- 
carried nearly every year since at about the fifth month. 
Commenced giving the medicine as soon as she felt the 
child, and gave it regularly a month, and afterward, when- 
ever she felt pain in her back. Went the full period, and 
did well. Has since had another. 

Case 7. — A sister of the last, living with the minor 
heirs of E. Hearn, was similarly unfortunate; had had 



874 MIDWIFERY. 

many miscarriages about the third month. Commenced 
giving her the medicine as soon as pregnancy was known, 
and continued it until quickening. Did well. 

Many other similar cases could be given, but these are 
deemed sufficient. It will be observed that in all the above 
cases, child-bearing was commenced quite young; and my 
recollection is, that all were of a lax fibre and nervous 
temperament. In the treatment of the above, and similar 
cases, the form of the medicine was varied to suit the incli- 
nation of the patient — some preferring that of pills, and 
others a syrup ; and the quantity was also proportioned to 
their susceptibilities. Other remedies were also added, to 
meet such indications as presented ; usually nothing more, 
however, than a little blue-mass when the liver was torpid, 
or butternut when there was slowness of the bowels. To 
sum up the purposes for which I give the above remedy : I 
give it in all cases of threatened abortion, when not caused 
by accidents or severe sickness. I use it for all the name- 
less pains, aches, and disquietudes attendant on conception 
and gestation. I give it to prevent, and to remove when 
present, premature and erratic pains in the latter stage of 
pregnancy. In fact, in all cases in which I am previously 
spoken to, I put the patient upon its use a week or more 
before the expected confinement, for the purpose of remov- 
ing any excessive nervous excitement of the general sys- 
tem, especially of the os uteri; thus preparing it to yield 
kindly to uterine contraction ; and after delivery, I give it 
to soothe the excited system, and prevent those spasmodic 
contractions called after-pains. I know that many consider 
these pains to be necessary and salutary, but females with 
first children, when the tonic contraction of the uterus is 
good, do not have them; and I also know that in after- 
labors they have, in my practice, done very well without 
them. 

Case 1. — I will now give some cases of a different cha- 
racter from the above. In January of 1849, I was called 

on by a Mr. B , who had lately moved within six miles 

of me, and with whom I had had no previous acquaintance, 
who wished me to cause his wife to abort. He informed 



DISEASES PECULIAR TO PREGNANCY. 875 

me (which I afterward found to be correct from other 
sources) that his wife had, the previous year, come to the 
full period of pregnancy, and that, although he had the 
services of several experienced accoucheurs, they were 
unable to deliver her without literally taking the child to 
pieces, and that they informed him that his wife never 
could bring forth a living child. He also informed me that 
two of her married sisters had to have their children 
delivered in this manner. 

I consented to visit his wife, telling him at the same time 
that I did not expect to procure abortion. I found her a 
fine-looking lady, rather short for her weight, large muscu- 
lar developments, and flesh unusually firm. I made an 
examination per vaginam, and found, indeed, but very little 
space, owing principally to the fulness and firmness of the 
soft parts. But my conclusion was, that there was bony 
room sufficient to admit of the passage of a common-sized 
head. I accordingly positively refused to procure abortion, 
but expressed myself confidently that I could put her upon 
a regimen that would enable her to have a living child. 
This was about the third month, and I requested him to 
visit me on the seventh for further instructions ; for the 
present I recommended nothing more than a teaspoonful of 
epsom salts daily, to keep her system cool. He called at 
the time directed, and I sent tincture of valerian, with 
vinous antimony sufficient to slightly nauseate the stomach, 
which, besides other benefits, would enable her more effect- 
ually to carry out my injunctions of low diet. The vale- 
rian being a good diuretic, would serve to keep up a drain 
from the kidneys, and I directed the salts to be taken daily, 
in such quantity as would secure a moderate purgative 
effect on the bowels. I also sent a box of the pills of 
hyoscyamus, to be taken freely during the last stage of 
gestation. At the full period I was sent for, and was 
pleased to find that my plan had worked well. There was 
still a good deal of embonpoint, but the textures were all 
soft and pliant ; and on examination, I found a fine dilatable 
condition of the soft parts. In short, after a common labor, 
she was delivered of a sprightly common-sized child. It 



876 MIDWIFERY. 

was characteristic of the family to have large children ; and 
my plan of treatment contemplated a retarding of the 
growth of the foetus, as well as a softening of the textures 
of the mother. 

I had often witnessed this effect follow daily purgation, 
when brought about for other purposes. This was the 
first instance in which I availed myself of this means in- 
tentionally. 

Case 2.— Mrs. A , wife of Mr. A , of Nashville, 

a respectable English lady. Had been married over twelve 
years, and had never borne a child sufficiently matured to 
live ; had generally miscarried between the sixth and seventh 
months, sometimes between the third and fourth. These 
misfortunes finally undermined her health, and the usual 
symptoms of uterine, hepatic, and gastric derangements 
became prominent, and finally, in the fall of 1852, she pre- 
sented the symptoms of jaundice in marked form. She 
obtained the advice of several scientific physicians, but 
failed to receive more than partial and temporary relief; and 
for several months had run the round of irregulars and 
nostrum-venders. At certain intervals her stomach would 
sympathize so strongly with the deranged liver and uteris, 
as to throw her into most intense suffering ; and during one 
of these attacks I was consulted. I found her with great 
tenderness of the epigastrium ; frequent retching to vomit ; 
distressing pain in the right hypochonclrium, with evident 
enlargement ; extremities cold, with skin the color of a very 
dark orange ; discharges from the bowels like white pipe- 
clay ; urine almost black. She informed me that her skin 
had been the present color, with slight variations, for seven 
or eight months ; and that during that time there had not 
been the least trace of bile seen in the discharges. Treat- 
ment : a mustard bath to the feet ; a large blister over the 
liver ; a blue-pill every six hours ; and a tablespoonful of 
the comp. syrup of valerian every two hours. On the 
morning of the third day I had the pleasure of witnessing 
the following favorable symptoms : distress and anxiety en- 
tirely subsided ; pain in the right side gone ; copious dark 
bilious dejections from the bowels ; free discharge of natura] 



DISEASES PECULIAR TO PREGNANCY. 877 

urine, etc. From this time her recovery was rapid ; in a 
week her skin was clear, her tongue clean, and her spirits 
buoyant. But in order to prevent a relapse, the syrup was 
continued three times a day for several weeks. I now in- 
formed her that in all probability she would soon become 
pregnant again ; but that if she would inform me when the 
event happened, and put herself under my treatment, I 
thought I could enable her to go through the period of ges- 
tation and bear a living child. Accordingly, in a short time 

Mr. A informed me that he believed his wife was 

enciente, and on visiting her I was convinced that he was 
correct ; I therefore immediately put her upon the use of 
the following formula, which I have named Anodyne Alterant. 
Extract hyoscyamus, one ounce; extract butternut, seven 
ounces; oil sassafras, half an ounce; sup. carb. soda, two 
ounces ; simple syrup, two quarts. 

I directed her to use just enough of this to keep up a 
regular condition of the bowels, and to prevent all irregular 
action of the uterus. Under this treatment she got along 
very finely until about the middle of the seventh month, 
when there was an evident disposition manifested by the 
uterus to expel the foetus. Believing that the organ, hav- 
ing formed a habit of expelling its contents prematurely, 
would not bear much further distention, I thought best to 
make an effort to arrest any further develojmient of the 
foetus ; and having succeeded in producing this effect in 
several other cases in which I thought it advisable, by a 
free use of this medicine, I directed her to increase the dose, 
so as to produce tolerably free purgation. This effect was 
steadily kept up during the remainder of the term, and no 
more unpleasant symptoms occurred. At the full ferm I 
was called on, and, after a rather tedious but not difficult 
labor, delivered her of a fine, well-formed female child, 
weighing five pounds. The mother and child both did well. 

In about two years Mrs. A again became pregnant; 

and being now in good health, thought it unnecessary to 
apply for medical advice ; nothing unusual happened until 
about the sixth month, when labor-pains suddenly came on ; 
the foetus was expelled. Six months subsequent, she had 



878 MIDWIFERY. 

the usual evidence that conception had taken place, and ap- 
plied to me for aid. I placed her upon the same treatment 
as on the former occasion, giving the comp. syrup of butter- 
nut freely, after the sixth month, with an occasional blue- 
mass pill, with a view of retarding the development of the 
child, which it did as before, and with a like happy result. 
Both children are now living, one five and the other two 
years old. 

Dr. Moses, of Eldridge, Ala., writes : 

" Your comp. syrup of butternut for the relief of females 
I have used frequently, and with not only the happiest re- 
sults to my patients, put also to myself, getting me a repu- 
tation, and large practice among that class of patients." 

Query : Would we not be justified in placing females 
under this treatment who habitually bear unusually large 
children, and consequently endure severe suffering ? So far 
as I have had experience, the treatment is entirely compati- 
ble with the best health to the mother, and safety to the 
child ; for, although small, they have uniformly been vigor- 
ous and healthy, and grew finely. 

Ten years' further experience has answered the above 
question satisfactorily in the affirmative. A reliable phy- 
sician from a neighboring county lately gave me the notes 
of an exceedingly interesting case which he had success- 
fully treated. In this case three children had, at as many 
births, been delivered by dissection. The bony pelvis had 
been distorted by rickets. He gave the compound syrup 
of butternut, in large purgative doses, during the entire 
period of pregnancy, and at the full time a child weighing 
three and one-half pounds was delivered, looking plump 
and vigorous, and is now a sprightly school-girl, and is the 
only representative of two wealthy families. 



PRACTICAL MIDWIFERY. 879 



CHAPTER IV. 

PRACTICAL MIDWIFERY. 

The period of utero-gestation, or pregnancy, in the human 
female is completed in about nine months ; but in some 
cases it falls short of this time a few days, and in others is 
protracted considerably beyond it. Women commonly have 
some premonitions or intimations of approaching labor for 
some days before it commences ; such as a subsidence of the 
belly, its becoming harder and firmer than usual, and a 
greater feeling of weight. There is also usually more or 
less discharge from the vagina of a watery secretion, which 
is sometimes tinged with blood, and is called a show. Pains 
finally come on, at first slight and far between, but gradu- 
ally increasing both in severity and frequency. These pains 
usually start in the lower part of the small of the back, and 
extend round the most dependent part of the belly ; they 
are not what are known as bearing or pressing pains, but 
are described as cutting, or tearing, or grinding. These 
pains may continue some hours, or for some days, with but 
little change, and greatly harass and fatigue the woman, 
and are borne with the less patience, because they apparent- 
ly " do no good ;" but this is a mistake, as they are the 
effect of the contraction of the fibres of the womb, whose 
office is to dilate or open its mouth, and make a way for the 
escape of the child when expulsive or bearing down pains 
come on. Much, however, may be done toward mitigating 
these pains, without destroying their effects. Any means 
that will assist to produce relaxation and lessen sensibility 
will be useful for this purpose \ such as moving the bowels 
56 



880 MIDWIFERY. 

by castor oil, or salts, or seidlitz powders, or by injections 
of warm, weak soapsuds ; or sitting over the steam of warm 
water in which tansy or other bitter herbs has been infused; 
or the warm hip-bath 3 or applying cloths wrung out of hot 
water to the vulva and lower part of the belly. Besides 
these external means, various internal anodynes may be re- 
sorted to, as a few grains of Dover's powder, or a teaspoon- 
ful or two of paregoric or Bateman's drops, or a cup of hot 
tea; but the greatest and most certain relief will be ob- 
tained by a tablespoonful of the anodyne alterant, which may 
be repeated every two hours, if necessary. 

Another advantage growing out of the use of the above 
means is, that if the pains are what are called false pains, 
they will be entirely relieved ; but true labor pains will not 
be suspended by any of the measures named ; but the suf- 
fering they occasion may be greatly lessened, and their 
object accomplished much sooner, in consequence of the in- 
creased tendency to relaxation which these means occasion. 
If the finger, after being well oiled, be introduced so as to 
reach the mouth of the womb, if the pains- be those of real 
labor, it will be found to be dilating ; and if, after the con- 
tinuance of these pains for some hours, there should be no 
effect made upon the os uteri or mouth of the womb, they may 
be known to be false pains ; and if the mild measures re- 
commended above should prove insufficient to arrest them, 
twenty or thirty drops of laudanum may be given. 

If these pains, constituting the first stage of labor, con- 
tinue long, and the child remain high, it may be owing to 
the child being pitched, as it is termed ; that is, the head 
does not present fair in the direction of the pelvis, but is 
thrown too much forward or backward, or to one side. The 
efforts of the womb will, in time, probably rectify this, but 
much may often be done by a little management, that will 
materially hasten the process. If, therefore, the os uteri be 
found pretty well dilated, but is pointing backward to the 
hollow of the sacrum, by introducing a finger into it, in the 
absence of a pain, it can be gently brought forward toward 
the pubes ; and, if held there until after the occurrence of 
a few pains, the head will usually descend so as to retain it 



PRACTICAL MIDWIFERY. 881 

in the right position. I could always reach the mouth of 
the womb more readily when the woman was sitting on the 
lap of an assistant. This is an unfashionable position ; but 
fashion must sometimes be made to yield to utility. After 
the position is rectified, the lady may resume the bed again. 

But if the head is found to rest on the pubes or front 
bone, the woman should be placed on her back, and pressure 
be made, during each pain, immediately above the bone, 
and, if the head be pitched too much to one side, she should 
be placed on that side, and pressure made upon the upper 
part of the uterine tumor from the opposite side. 

Sometimes, in consequence of an unusual amount of the 
waters, the child floats in such a way that it does not enter 
the bones of the pelvis, but may be felt at each pain to de- 
scend, and then to recede as soon as the pain ceases. This 
may continue many hours. Therefore, when I find the 
womb well opened, and the child floating out of my reach, 
after each pain, I have the patient placed upon the lap, so 
that the weight of the child may aid the pains ; and when 
the bag of water is distended during a pain, by a little 
scratching motion with the finger nail, which has been 
pared so as to have a point, I perforate the membrane, and 
cause the water to escape. 

Sometimes the water is nearly all above the child, and, 
during a pain, the head prevents its escape. In this case 
the finger can be introduced to the side of the head, and 
held there during a pain, so as to form a passage at its sides 
for the escape of the water. As soon as the womb has 
been partly emptied in this way, it seems to acquire much 
greater power of contraction, and a labor will often be fin- 
ished in half an hour, which would have required many 
hours without this assistance. 

But I wish to be distinctly understood that it is only after 
labor pains have continued for a considerable time, and the 
womb is fully open, that it becomes proper to rupture the 
membranes ; for should this be done prematurely, the labor 
will be much protracted. It is best for the woman to re- 
sume the bed as soon as the child's head has fairly entered 
the bones, as there will be little danger of its again reced- 



882 MIDWIFERY. 

ing. No further assistance will now be needed until the 
head passes the bones, and presses upon the perineum ; if 
this should be firm and unyielding, a cloth should be satu- 
rated with hot, greasy water, and held to the part, as warm 
as can be borne without being unpleasant. It is wonderful 
how much this simple measure will increase the disposition 
of the soft parts to dilate, and lessen the sufferings of the 
patient : it will also greatly lessen the probabilities of any 
laceration or tearing of the parts during the passage of the 
child. But further to guard against this accident, the assist- 
ant should place one hand flat against the underside of the 
protruding tumor, and press a little backward, and at the 
same time, with the other hand, gently *push the soft parts 
at the upper part of the vulva, so as to facilitate the escape 
of the head through them. 

Sometimes the womb descends, and seems inclined to 
pass out with the child. In this case, the fingers should be 
placed flat against its edge, next the pubes, and the womb 
pressed back, so as to make it slip over the head. As soon 
as the head has escaped, the assistant should examine to 
see if the cord be round the neck, and, if so, it must be 
slipped over the head, or back over the shoulders, or, if 
neither can be done, the head of the child must be held as 
near the pubes of the mother as possible, while the body 
and breach are made to emerge in a curve. If this be not 
done, the cord, if short, or many times wrapped round the 
child, may be drawn so tight as to strangle it, or it may 
cause the fundes of the womb to be dragged down, as the 
child is expelled, and produce that distressing state of things 
known as inversion of the womb. The exercise of a little 
tact and presence of mind on the part of the operator may 
always prevent the occurrence of either of these serious 
accidents. 

As soon as the child is born, it should be laid upon a dry 
cloth, at a sufficient distance from the mother to be out of 
the way of the water, which is generally considerable, but 
not far enough to put the cord on a stretch. If the child 
should not cry, you should see whether it breathes, and if 
not, sprinkle its breast with a little cold water ; and apply 



PRACTICAL MIDWIFERY. 883 

whiskey or camphor to the head. If there be good pulsa- 
tion in the cord, there will be little danger but the child 
will soon show signs of life ; but if the circulation be found 
to be suspended in the cord, it should be immediately tied, 
and the child separated, and immersed in water as warm as 
can be borne without injuring the skin, taking care to keep 
the face out of water. Recollect that tepid or lukewarm 
water is debilitating, but that hot water is stimulating ; and 
if the water is not hot enough to act as a stimulant, it is 
best to wait until it can be heated, and in the meantime 
use frictions with dry warm flannel or with the hand. 

If these means fail to produce signs of life, you may try 
artificial respiration; this may be done by placing your 
mouth to its mouth, and, holding its nose, blow gently until 
its lungs are inflated, or filled with air ; then press upon its 
belly upward and cause the air to escape ; this should be 
repeated at short intervals until the child revives, or you 
become convinced that vitality has wholly left it. 

Before the child is born, you should always prepare a 
string for tying the cord, so that it may be made right, 
and be at hand when wanted. It should be made of strong 
cotton or flax thread, several strands being twisted together 
and well waxed; the tie should be made at about two 
inches from the child, and should be sufficiently tight to 
effectually prevent bleeding, but not so tight as to cut the 
cord ; another tie should be made two inches farther 
toward the mother, and then the cord cut between them. 
As soon as the child is cared for, you should turn your 
attention to the mother, and ascertain if there be much 
bleeding ; if there is, you should move your hand over the 
belly until you feel the womb, which probably will be found 
about the region of the navel, grasp it pretty firmly, press- 
ing downward and backward, which will cause it to contract 
and close the bleeding vessels, and, at the same time, expel 
the after-birth. But if this should not succeed, tighten the 
cord with your left hand, and with the forefinger of the 
right follow the cord to the mouth of the womb, and turn 
it round within the neck, which will probably excite the 
necessary contraction. But if this also fail, you must pass 



884 MIDWIFERY. 

the hand into the womb, and grasp the placenta ; by this 
act you will necessarily bring your knuckles into contact 
with the womb, which will hardly fail to excite contraction ; 
now hold still, keeping the placenta grasped, until the 
pains, or rather the uterine contraction which causes them, 
expel the hand and the after-birth with it. If there even 
should be no considerable flooding, provided the womb does 
not contract so as to expel the after-birth in ihe course of 
fifteen or twenty minutes after the birth of the child, you 
should go through the above proceedings, and insure its 
early expulsion. Authors differ greatly as to the length of 
time which it is proper to wait for pains to come on for 
expelling the after-birth ; but as the woman is in constant 
danger from flooding until it is discharged, and as the 
longer it is delayed the greater will be the danger of an 
irregular contraction taking place, called hour-glass con- 
traction, by which the delivery of the placenta is made 
extremely difficult ; and as there is never any thing gained 
by delay, I always proceed, after the woman has rested a 
little, to use the above measures for exciting pains, observ- 
ing the order in which they are named, and never cease 
until I have accomplished a perfect delivery ; and no acci- 
dent has ever arisen from this timely assistance, but I have 
many times been called to cases of hour-glass contraction 
which might have been prevented by these harmless means 
of exciting the expulsive efforts of the womb. I was once 
called to a very interesting case of this kind. The lady 
had been attended by an experienced and one of the few 
prudent mid wives, who informed me on my arrival that the 
case was a strange one — that there was no after-birth, but 
that the navel string grew out of the womb. Upon exami- 
nation, I found that it appeared to be actually as she had 
told me — the cord appearing to enter the substance of the 
uterus at about the middle of the fundes ; but I knew this 
could only be apparently so, and that it was a case of com- 
plete hour-glass contraction, and proceeded to press my 
finger firmly at the side of the cord ; after some time, the 
contraction yielded in a degree, and the finger passed up 
by the side of the cord, and touched the placenta. I now 



PRACTICAL MIDWIFERY. 885 

brought all my fingers together, and again made gradual 
firm pressure against this ring-like contraction, while, with 
the left hand upon the belly, I pressed the womb down, 
and, by exercising patience, finally succeeded in passing the 
whole hand through the point of contraction, and brought 
the palm flat against the placenta ; this was finally grasped, 
and by a gentle but firm downward effort was brought 
through the contraction and delivered. The lady suffered 
a good deal from the introduction of the hand, which is 
always the case; but as soon as complete delivery was 
accomplished, this was all over, and she did as well as 
usual. Sometimes the placenta adheres with unusual firm- 
ness to the uterus ; in fact, I suppose always does in hour- 
glass contractions, which indeed is the cause of this 
accident — the unyielding mass preventing the contraction 
of the womb at this point; for did contraction take place, 
the after-birth would of necessity become detached ; but, as 
we said, the attachment between the two is occasionally so 
firm as to prevent the contraction, and may require con- 
siderable pressure with the finger to break if up. This 
pressure should always be applied to the placenta so as to 
force it from the surface of the womb, and not against the 
surface of the uterus, or it may be injured and inflammation 
follow. 

I suppose these cases of unusual adhesion of the placenta 
are always the consequence of a degree of inflammation in 
the uterus, occasioned by falls or other causes sufficient to 
cause coagulable or plastic lymph to be thrown out, as in 
pleurisy, by which surfaces lying in contact become glued 
together. 

MANAGEMENT OF THE WOMAN AFTER DELIVERY. 

You should never leave the bedside after the delivery of 
the after-birth until you are certain that the womb has con- 
tracted ; therefore, if upon examining the belly you find 
that the womb is still large, and feels soft, you should 
excite contraction by all the gentle means before recom- 
mended, as grasping the womb, friction over the abdomen 
with the hand, dipping the hand in cold water and then 



886 MIDWIFERY. 

grasping the uterus, etc. If there should be much wasting, 
stir a teaspoonful of flour into a glass of cold water, and let 
the patient take it at a draught. This remedy, though 
apparently very simple, acts more promptly in arresting 
profuse bleeding from the womb, as well as from any other 
internal organ, than any other I have ever tried. Cloths 
wet in cold whiskey may also be applied to the vulva and 
belly. Twenty or thirty drops of laudanum, or a grain of 
opium, may be given, which will powerfully aid in bringing 
about a permanent contraction, and guard against a return 
of the hemorrhage. 

A broad bandage, made to fit neatly over the abdomen, 
will also very much aid in preventing flooding ; and, besides 
this, it makes the woman feel more comfortable, and is 
thought to preserve her proper shape, and prevent a pendu- 
lous abdomen ; but when a bandage is made to act as a cord 
or ligature around the belly, it becomes highly pernicious ; 
it therefore should be neatly applied, or left off entirely. 

If after-pains should be troublesome, a cloth saturated 
with camphor and laudanum may be applied above the pubes ; 
or scalded double tansy, or hot whiskey, may be used in- 
stead. Small doses of opium, or Dover's powder, may be 
given at short intervals ; or, what is better, a tablespoonful 
of the anodyne alterant, which may be repeated every three 
or four hours until it acts upon the bowels. The patient 
should at first be made warm, if she feels chilly, which she 
often does, with dry warm flannels ; but after reaction is 
established, all unnecessary covering should be removed, as 
by causing perspiration she will be more likely to take cold. 
The diet should be light for a few days, and the bowels 
moved, if necessary, with castor oil or clysters. 

If there should be much milk fever, warm teas should be 
given, and cloths wrung out of hot water applied to the 
abdomen ; a few grains of ipecac, in a glass of water, and a 
tablespoonful given every hour or two, will greatly aid the 
other means. 

The child should be put to the breast soon after it is born, 
so as to open the milk tubes ; even should it get ever so 
little from the breast, this will perhaps prevent difficulty 



PRACTICAL MIDWIFERY. 887 

when the milk does come. If the breasts should become 
hard, they should be covered with cloths wrung out of hot 
water containing bitter herbs ; or a batter-cake, fried in lard 
until it is about half cooked, may be placed over them, and 
renewed occasionally . But if these means fail, and the breasts 
be about to rise, heat an equal quantity of tar and old bacon 
grease, and cover the breast with cloths dipped in this. It is 
not a sightly remedy, but it is the most certain of any of which 
I have any knowledge ; in fact, I have never known it to fail, 
if applied before matter was formed, and even after that event 
it will allay the pain and greatly lessen the amount of the 
rising. When matter is formed, the breast should be lanced as 
early as possible, and then dressed with the above application, 
and it will prevent any further progress in the disease, and 
soon accomplish a complete cure. 

MANAGEMENT OF THE CHILD. 

As soon as the mother has been properly cared for, the 
child should claim your attention. There is usually a 
whitish matter adhering more or less extensively to the 
surface, which is not soluble in soap and water, and great 
injury is often done by endeavors to remove it. But, though 
soap has no effect in softening it, oil combines with it very 
readily ; therefore, lard should be applied freely to all that 
part of the surface on which it is found, and in a very few 
minutes, by gently rubbing with a sponge or soft cloth, it 
can be easily removed. 

I should join many of the best authors in wholly con- 
demning the use of soap in cleansing a new-born child, but 
I suppose it would be unavailing : it would still be done, 
notwithstanding; I would however pray that the soap be 
mild, and but sparingly used, as the delicate surface of the 
infant is exceedingly sensitive, and great nervous prostra- 
tion, causing fainting, convulsions, colic, etc., may result 
from the harsh action of so pungent an application as soap 
to the whole body of the little victim to false notions of 
cleanliness. I would say, don't wash the child at all, but 
grease it, and wipe it clean. A soft cloth should now be 
folded into a fan shape, and the angle, which will be the 



888 MIDWIFERY. 

middle of the cloth when opened, should be held against a 
live coal, or to a candle, until a hole is burnt as large as a 
dime ; the margin of this should now be greased, and the 
navel-cord brought through it, and then laid straight up- 
ward on the belly, and the cloth then folded smoothly bver, 
and then a bandage or belly-band adjusted smoothly and 
moderately tight, so as to keep it in place. Much injury is 
often done by drawing the belly-band too tight ; it should 
always be loose enough to easily admit of your finger being 
moved under it. If the child appears to be cold, as they 
nearly always do, it should be warmed by wrapping it in 
hot flannel and laying it beside its mother. If it should 
have the snuffles, apply oil or lard to the surface of the nose. 
If it be pestered with phlegm in its throat, give it a little 
oil and molasses and grease its breast, over which apply a 
warm flannel. 

If you want a good baby, you must have a healthy one, 
and, in order to have a healthy one, you must in the first 
place furnish it with healthful nourishment ; and the best 
will be its mother's milk, provided she be in good health ; 
if not, the milk of some other healthy woman ; next to this, 
fresh cow's milk, with a third water, and a little loaf-sugar; or 
the water off of boiled crusts of bread, sweetened with loaf- 
sugar. Children artificially fed are usually killed by over- 
feeding ; better starve them a little than to ruin their diges- 
tion by over-distending the stomach. 

But, besides good nourishment, if you want a good baby, 
you must attend to its comfort in every respect ; it should 
be dressed according to the season — always, though, in loose 
garments ; and must be kept principally in the dark : you 
must recollect that air and light are both powerful stimu- 
lants, and the child has been unused to them, and for the 
first few weeks it should therefore be fed and otherwise 
attended to, and then laid away out of sight, and only 
noticed as its wants demand. Thousands of babies are 
sacrificed every year to the vanity of dressing them up for 
show, and parading them on the arrival of every new visitor. 
Besides proper feeding, proper clothing, and laying them 
away in the dark to sleep, you must see that the bowels are 



PRACTICAL MIDWIFERY. 889 

regularly moved. Castor oil and molasses will be the best 
laxative if any be needed. 

We have now dwelt pretty fully upon a common case of 
labor, and given some plain directions for meeting the most 
common difficulties and casualties which attend or succeed 
it, and briefly touched upon the management of infants, and 
we think any thing further would be unprofitable; for, 
should we go into the detail of all the difficulties which may 
arise in the practice of midwifery, from wrong presentations 
of the child, or malformation of the mother, or from com- 
plications with diseases, etc., we would have to write another 
volume, and then you wouldn't read it, and if you did, 
would still not be competent to practice without also under- 
standing the entire science of medicine, and not even then, 
unless you should devote your entire attention to the sub- 
ject; for no man, however learned in medicine, and how 
extensive soever may have been his experience, is competent 
to manage difficult and complicated cases after he has with- 
drawn his attention from the subject for a few years, and 
pursued some other avocation, or had his mind diverted to 
other subjects. 



890 



MIDWIFERY. 



CHAPTER V. 

' DISEASES PECULIAR TO INFANTS. 

Most of the diseases usually arranged under the head of 
diseases of children, not being confined exclusively to the 
early period of life, have been treated under other and more 
appropriate heads, as measles, whooping-cough, croup, skin 
diseases, etc. ; there therefore remain but a few complaints 
of any moment yet to be considered, and the most import- 
ant is, 

HIVES RED-GUM, OR STROPHULUS. 

There is a certain disease well known to mothers and 
nurses, and country practitioners who have been some years 
in the practice, but the young physician may consult his 
standard works on practice in vain for any satisfactory 
description. Hence, he will most probably deny the exist- 
ence of any such disease as hives, except as another name 
for croup ; and yet he will presently be called to treat a 
case, occurring within the first month after birth, which he 
sees at once is not croup, but is an equally formidable dis- 
ease, and will most probably baffle all his skill, the infant 
dying in a few hours from strangulation. The women tell 
him the child died of hives ; and as it died, it was the bold 
hives — which name, fortunately for his reputation, saves 
him from all blame, as the general belief is that bold hives 
always kills. 

Upon a careful examination of authors upon this subject, 
I find the mild form of this disease is considered as a 
variety of red-gum, while the graver form is confounded 
with croup. Dr. Wood so treats it, describing the mild 



DISEASES PECULIAR TO INFANTS. 891 

form very accurately, as a variety of strophulus or red-gum, 
a general description of which, including this, he gives as 
follows : 

" In all its forms, strophulus is, with few exceptions, an 
acute disease, generally beginning to exfoliate and disappear 
in one or two weeks, and seldom continuing longer than a 
month. It is very rarely attended with fever, and often 
occurs without any observable disturbance of health. 
When febrile symptoms do occur, it is not always certain 
whether they are essentially associated with the eruption, 
or proceed from some other cause. Strophulus is almost 
always an innocent complaint. Its retrocession is thought 
sometimes to have been followed by serious internal irrita- 
tions ; but it is very difficult always to determine, in such 
cases, whether the disappearance of the eruption is cause or 
effect." 

Now, from this description, we would naturally conclude 
that the disease was of not much moment any way; not 
more important than itch, nettle-rash, milk-scab, etc. ; and 
yet, if you will inquire of country practitioners of what 
disease the most children die under six months, they will 
say hives. I have said country practitioners, for my obser- 
vations have led me to believe that the disease is much 
more common and more fatal in healthy country situations 
than in cities : for this, a reason will be given hereafter. I 
have so frequently seen this disease present symptoms not 
described in the books, and assume a character so much 
more grave than is assigned it by writers, that I have been 
almost ready to doubt its being the same malady ; but its 
milder forms being the same as described, I have concluded 
that some writer, centuries back, who had never seen the 
disease in its worst aspects, wrote a description of it, and 
others have merely copied without investigation. For 
some years past, I have embraced every opportunity of 
interrogating practitioners from every part of our country 
upon this subject, and have ascertained that they all are 
familiar with the disease in its gravest forms. I therefore 
take it for granted that it is a much more formidable 



892 



MIDWIFERY. 



disease throughout the world than agrees with the descrip- 
tions in the books. 

The only cause of difficulty in this disease referred to by 
authors, is when the eruption is repelled from the surface, 
and the irritation transferred to the stomach and bowels. 
But I have never known any very serious consequence 
arise from this cause; the means they all prescribe will 
usually meet the difficulty very promptly; viz., a warm 
bath, a gentle emetic, and a few testaceous powders. It is 
only when the irritation extends to the air-passages that 
the disease becomes really dangerous ; and this form has 
been wholly overlooked, or confounded with croup, by 
every writer I have had an opportunity of consulting. The 
eruption is not always repelled in these cases, neither do I 
believe that the irritation is even transferred from the sur- 
face to the air-passages, for I have often seen the rash 
plentifully on the skin, at the same time that the infant 
was threatened with suffocation from a filling up of the air- 
tubes by a thickening of their coats, and a secretion of 
tenacious mucus. It is true that the rash always fades 
before the child actually dies, because the capillary action 
has then become too low to sustain it ; but a striking in of 
the eruption is not the cause, nor is a transfer, but an 
extension of the irritation from the surface to the air- 
passages. Hence the means recommended by writers for 
the relief of cases in which the disease has been transferred 
to the stomach and bowels will, in this, prove of no avail, 
but may do positive harm ; for the means that will increase 
the eruption on the surface, will at the same time increase 
the irritation in the mucous lining of the air-passages, and, 
consequently, increase the morbid secretion which is already 
threatening suffocation. Whoever has tried nauseants and 
the ordinary warm bath in this disease, when there was 
considerable eruption on the surface, and the child breathing 
hurriedly, and auscultation detected very decided mucous 
rhoncus, has presently ascertained that he had gained 
nothing by the treatment, but injured his patient. For 
although nauseants, if carried to vomiting, may for a time 



DISEASES PECULIAR TO INFANTS. 893 

appear to have produced benefit, by disgorging the phlegm 
which was obstructing the bronchia, yet the formation of it 
is actually increased by the measure, and the little sufferer 
will presently breathe with more difficulty than ever. A 
repetition will obtain a still shorter respite, at the expense 
of a still more abundant secretion ; and if the practitioner 
now resorts to the warm bath, with a hope of succeeding, 
he will find the advantage obtained equally deceptive. 
While the child is in the water, the inhalation of hot vapor 
will, for a time, expand the lungs, and render the morbid 
secretion more fluid, so that the air finds a readier passage 
into the air-cells, and breathing is consequently easier ; but 
the bath is rapidly exhausting nervous power, which will 
soon reduce the vital action of the capillaries, disqualifying 
those of the lungs still further for returning to a healthy 
condition, and lessening the ability of the respiratory appa- 
ratus for taking on such action as is necessary for freeing 
the lungs from the accumulating mucus ; while at the same 
time the action of the bath upon the surface, by direct sym- 
pathy with the mucous lining of the bronchia, increases the 
amount of the secretion which is wanted to be thrown off. 
We see, therefore, good reasons why these measures which 
are mainly relied on, and which are so uniformly successful 
in relieving a transfer of the disease to the stomach and 
bowels, should not only fail to afford relief when the 
disease has extended to the lungs, but aid it in its too 
certain victory over the vital powers ; and the attendant 
will very soon have the mortification to see his little patient 
turning livid from a failure in the aeration of the blood, and 
still less able to make the extraordinary respiratory efforts 
required for forcing the air through the tenacious mucus, or 
to discharge it. But fortunately, while the black blood 
sent to the brain is destroying nervous power, it also 
destroys sensibility, and all conscious suffering is soon at 
an end ; and coma, being presently followed by asphyxia, 
soon terminates the struggle. Now, as children who die of 
this form of disease always turn livid, presenting purple 
spots before they die, or immediately after, if convulsions 
have hastened death before asphyxia had time to do its 



894 



MIDWIFERY. 



work, the matrons of the land call it the hold hives ; and 
hence, as this appearance is never presented until death is 
inevitable, or has actually taken place, the opinion is well 
founded that hold hives is never cured. As children who 
die of croup generally present this same appearance, and 
from the same cause, it is generally confounded with this 
form of hives by nurses, as well as by doctors. But they 
are very different diseases — this is peculiar to early in- 
fancy ; I have known of no case occurring after the first 
year, and rarely after six months, and by far the greater 
number happen within the first month after birth; but 
croup is not a disease of infancy ; few cases happen under 
two or three years. Then, again, they affect different loca- 
tions : croup is a cynanchia trachialis, and this a cynanchia 
hronchialis — that is, croup is located in the wind-pipe, and 
mostly at its upper extremity, while this is located in the 
minute branches, and perhaps in the air-cells ; croup is cha- 
racterized by a shrill sound, as if breathing through a 
metallic tube, or like the crowing of a cock, as the name 
implies ; but this is known by a flat plashing sound, as of 
air passing through water, or more like gas escaping from 
paste while boiling; it resembles mucous rale in pneumonia 
more than any thing else, and is the result of about the 
same condition. 

But though croup and this form of hives are very 
different in their commencement, they run very near 
together in their termination ; both usually kill by pro- 
ducing asphyxia ; and croup, though always attacking the 
upper part of the trachea at the commeVcement, often 
extends its influence downward, until, if protracted, it is 
seen to produce the identical effects upon the minute 
branches, and the air-cells, characteristic of hives, occa- 
sioning, too, the same rapid accumulation of morbid secre- 
tion. 

I have already hinted that this form of hives is probably 
much less prevalent in cities than in the country, and I 
now say it is more prevalent in the most healthy regions of 
country ; the same I think will be found to be true also of 
croup; and the reason that both are the most prevalent 



DISEASES PECULIAR TO INFANTS. 895 

where there is the highest health, is because both are dis- 
eases of high action, laying hold of the most precocious 
developments of the sanguino-nervous temperament. This 
being the kind of subject most commonly attacked by this 
form of hives, it may readily be perceived why it should 
be seldom met with in city practice, such constitutions 
being rarely found there among infants ; and it also ex- 
plains the omission of writers to notice the disease, as all, 
as far as I know, have learned disease as presented in 
cities. 

Treatment. — The disease, then, at its commencement, 
being one of high action, the indications are for the use of 
such measures as will subdue over-action ; but while select- 
ing them, we must remember also that our patient, though 
robust and sanguine, is also highly nervous and excitable, 
rendering the system extremely subject to collapse of 
nervous power ; we must not, therefore, make any heavy 
drafts upon the source of vital energy ; hence bold depletory 
measures are entirely out of the question ; such means only 
should be resorted to as will subdue excessive arterial 
action, with the least expense to the general strength, com- 
bined with appropriate means for allaying nervous excita- 
bility. I am not at all certain that I have fallen upon the 
best possible measures for fulfilling these indications, for all 
my efforts have occasionally failed of success, but have 
proved much more certain than the plan I was taught and 
practiced in my early professional career. They are as 
follows : When called to see an infant, and I perceive its 
face flushed, eyes somewhat suffused and slightly injected, 
considerable restlessness, not' crying as from pain, but 
making rather a grunting moan, often desiring a change of 
position, seizing hold of the breast with energy, but letting 
go after a few draws as though for want of breath, breath- 
ing rather short, and more than usual heaving of the chest, 
I suspect at once that I have this disease to contend with, 
and inquire of the mother or nurse if the child has had any 
breaking out. If I am informed that it has not, I examine 
still closer the condition of the surface, and I will perhaps 
detect the appearance of an eruption within the skin ; but 
57 



896 MIDWIFERY. 

if this should fail to be detected, I proceed further, and, 
having the infant's face turned toward a strong light, I 
excite it to cry, so that the fauces and pharynx may be 
fully exposed; and if the surface appears to be suffused, 
with more or less distinct evidence of a fine papillary erup- 
tion, I become satisfied it is this form of hives, but that it 
has commenced in the air-passages, and has not yet ex- 
tended to the general surface. In this stage there is not 
much secretion from the mucous lining, the difficulty in 
breathing being occasioned by over-fulness of the vessels, 
and a thickening of the lining of the cells and air-passages. 
In this stage I direct a mustard bath, as warm as the child 
can bear without occasioning positive suffering, the object 
of which is to equalize the circulation, and invite the erup- 
tion to the skin, so as to produce an equilibrium of action 
between the external and internal surfaces. This bathing 
should only be continued a few minutes at a time, and the 
child enveloped in a light flannel in the interim; at the 
same time I administer, internally, grain doses of calomel 
every hour, and a tablespoonful of catnip or hop tea every 
fifteen minutes. The mercurial is given to produce revul- 
sion to the liver, and also to make that organ perforin some 
of the labor usually assigned to the lungs. As soon as 
bilious discharges are obtained I discontinue the calomel, 
but continue the tea, for the purpose of quieting nervous 
excitement and maintaining the action on the liver and 
bowels. These measures will rarely fail to procure entire 
and permanent relief. But if I have been called in later, 
and find the child breathing with great difficulty, and 
exhibiting the peculiar sounds indicating profuse secretion 
in the air-vesicles, the countenance anxious and distressed, 
the pulse hurried, etc., I adopt a very different set of 
means. In this case the excessive secretion must be dimin- 
ished, or the child will inevitably die of asphyxia ; it can- 
not be thrown off fast enough, by any means which can be 
devised, to prevent a fatal accumulation. My only hope 
now is in the cold wet sheet. I order a panful of cold water, 
and another of very warm water, and dipping a large 
towel, or some other conveniently obtained cloth, in the 



DISEASES PECULIAR TO INFANTS. 897 

warm water, envelop the child's lower extremities in it; 
and then saturating another in cold water, apply it around 
its naked body, and over it a dry flannel. As soon as 
reaction is fairly established, I remove the cloths, not 
desiring a perspiration. I give nothing in this case but the 
teas above named, administered cold. A fresh application 
of the cloths should be made every hour or so, until entire 
relief is obtained ; then calomel may be administered as 
before, for the purpose of revulsion, and to free the blood 
from the carbon which- has accumulated in consequence of 
imperfect aeration. If given sooner, the sickness occasioned 
by it might have completed the prostration. The rationale 
of the cold application is easily given — it arrests the mor- 
bid secretions, just as it does internal hemorrhage, by 
acting as an astringent; it also excites the surface. I 
deprecate a sweat, because it would invite an increase of 
the secretion in the lungs, by concert of action with the 
surface. 

CYNANCHIA TRACHIALIS CROUP. 

This is a disease of high action, most prevalent in healthy 
country situations, and in northern latitudes. It is seen 
much more frequently to the north of Mason & Dixon's line 
in our country than to the south. I met with ten cases of 
this disease in Ohio, in the same amount of practice, to one 
in Tennessee. Here, the great majority of the cases which 
I have seen, that were supposed to be croup, were nothing 
more than common cold in a phthisical child ; the stifled 
, cough and wheezing respirations of which are easily dis- 
tinguished from the ringing cough and crowing respiration 
of cynanchia trachialis. This misnaming of the disease has 
led many to look upon croup as rather a slight complaint, 
w T hich a warm bath, or a snuff plaster to relax spasm, and 
a little melted butter and honey to allay the tickling of the 
glottis, are fully able to subdue. But croup lays hold with 
a giant grasp, and demands the prompt interference of our 
most efficient measures to meet it successfully. 

In the management of the first stage of this disease, I 
have never been able to improve upon the plan taught me 



898 MIDWIFERY. 

by Doctors Hamilton and Judkins, then of Mt. Pleasant, 
Ohio, when a student of medicine ; which was the warm 
bath, and calomel and ipecac, in such doses as would pro- 
duce, first, active emesis, and then a brisk cathartic effect ; 
and, at the same time, a fly-blister to the throat and upper 
part of the chest. As there is usually great insensibility 
to the influence of medicine in this disease, the dose must 
be very large, say from ten to twenty grains of each, and 
then made to act as an emetic, by free draughts of weak 
mustard water. This plan will fail in very few cases to give 
entire relief, if adopted early ; but if the disease has pro- 
gressed until it begins to assimilate the severe form of hives, 
described in the last chapter, these measures become very 
hazardous ; and for reasons therein given. I treat this stage 
of croup just as I do the advanced stage of hives, to which 
I will refer the reader. I would even now, however, apply 
the blister as soon as considerable relief had been obtained 
by the cold cloths, in order to prevent a relapse. 

OPHTHALMIA. 

This disease might have been arranged under particular 
inflammation ; but as the cases which most often demand 
our attention, and involve the greatest danger of a disor- 
ganization of the eye, are met with in early infancy, in order 
to give prominency to this fact, I have reserved its considera- 
tion for the present chapter. 

When called to a case laboring under this disease, we 
should consider whether it is catarrhal, malarious, or scrofu- 
lous, as our diagnosis must, to some extent, determine the 
plan of treatment. This distinction can generally be made 
with ease, but occasionally it is quite difficult. In fact, a 
case may be the combined result of several causes, and pre- 
sent a mixed character, in which it may be difficult to de- 
termine which element preponderates. A person, for ex- 
ample, may have been impressed by malaria, and then 
exposed to atmospherical vicissitudes ; and both of these 
causes may operate upon a scrofulous constitution, and then 
the case might be both catarrhal, malarious, and scrofulous. 
But generally one of these causes so far impresses itself 



DISEASES PECULIAR TO INFANTS. 899 

upon the disease, as to give it character, and determine the 
peculiarity of treatment. Common catarrhal or inflamma- 
tory ophthalmia is usually recognized by the mode of its 
accession, it being ushered in along with other symptoms of 
cold. But little skill and less medicine are necessary to 
manage this form of sore eyes successfully, if taken at an 
early stage. A dose or two of epsom salts, a hot mustard 
foot-bath, and bathing the eyes in warm water, will effect 
very certain and speedy relief. But if the attack comes on 
after exposure to a malarious atmosphere, and is ushered in 
with many of the symptoms commonly associated with an 
attack of malarious fever, such as headache, loss of appetite, 
dinginess of the surface, a sense of weakness, etc., we may 
safely consider it malarious ophthalmia, and treat it as we 
would an attack of bilious fever, with calomel, quinine, etc., 
paying very little attention to the local disease of the eyes. 
But if the patient has had an attack of sore eyes, without 
any of the common symptoms of cold, or those of the first 
stage of bilious fever, the first indisposition being an unu- 
sual sensibility of the eye to light, subsequently becoming 
a dark-red, and always being much relieved by shutting out 
the light ; and especially if we detect other evidences of a 
scrofulous diathesis, we may, without hesitation, set it down 
a case of scrofulous ophthalmia, and treat it accordingly. 
The plan which has succeeded best in my hands in managing 
this form of sore eyes is, to put the patient upon an altera- 
tive course of medicine internally, and apply anodyne collyria 
to the eye. The best alterative course is sarsaparilla and 
iodide of potassa ; and, as a local application, I have found 
nothing to compare with the following : Spirits of nitre, one 
ounce ; chloroform, one ounce ; morphine, five grains ; rose- 
water, four ounces ; saturate raw cotton and bind it to the 
eyes on going to bed. 

I will illustrate the effect of this treatment by reporting 
a case. In the spring of 1854, I was called to see a little 
daughter of Mrs. Lane, South Vine street. I found Ihe 
child's eyes so exceedingly sensitive, that it was with great 
difficulty I could examine them at all. They were swelled 
and deeply injected with blood, and had to be covered with 



900 MIDWIFERY. 

several folds of some dark material to keep down intense 
suffering ; yet when it was quite dark, she could uncover 
her eyes, and. would play about the yard with as much glee 
as children usually do in the day. Her mother informed 
me that she had suffered in the same way the most of the 
summer of '53, and that medical aid had been resorted to 
without benefit. I looked upon the disease as inflammatory, 
complicated with chylopoetic derangement, and put her upon 
strict diet, purgatives, and cooling applications to the eyes, 
but no benefit followed. And after trying my prescription 
for several weeks, it was dropped, and another physician, 
eminent for his skill, called to take charge of the case ; who, 
taking the same view of the case which I had, pursued a 
similar mode of treatment, with a like want of success. 
She was then taken to the Springs, but still obtained no 
relief; but as the weather became cool, she gradually im- 
proved, and remained pretty clear of suffering all winter. 
Being at the house on some other occasion, I examined her 
eyes, and found that one had suffered but little, but there 
was considerable opacity of the cornea of the other. I now 
began to suspect that I, as well as all the other physicians 
who had attended on the child, had mistaken the nature of 
the case ; that the disease was not primarily inflammatory, 
but that the child was of a scrofulous habit, and that the 
disease first manifested itself by morbid sensibility of the 
retina ; and that the intense irritation of light, acting upon 
this morbidly sensitive nerve, created so much irritation as 
to set up inflammation in the organ. I informed Mrs. Lane 
that I thought I had a better understanding of the disease 
than I had had the previous summer, and that if the child's 
eyes commenced getting worse, as usual, in the spring, I 
would like to watch them. I was accordingly sent for, and 
found that I was correct, so far as the origin was concerned : 
that the morbid sensibility was the cause of the inflamma- 
tion, and not it, as we all had supposed, the cause of the 
sensibility. I did nothing for a time but watch the progress 
of the disease, until it had assumed a virulence equal to any 
previous attack. I then put her upon the plan stated above, 
and in a very few days had the satisfaction of seeing a 



DISEASES PECULIAR TO INFANTS. 901 

decided amendment ; and in a few weeks the disease was 
so effectually removed, that she could run in the sun with- 
out a bonnet, and has remained well until now, notwith- 
standing she went through the ordeal of an attack of measles 
during the summer. The plan pursued was, to apply 
pledgets of cotton, saturated with the collyria, to the eye 
every night on going to bed ; remove them in the morning 
and let them remain off an hour or so, and then reapply, 
and keep them on until evening ; then again leave them off 
an hour or two. After considerable amendment, the appli- 
cation was only made at night ; and finally, only occasion- 
ally. The internal medicine was composed as follows : two 
ounces of comp. syrup valerian, (my common fever syrup,) 
two ounces of comp. extract sarsaparilla, and one drachm of 
iodide of potassium. Of this I ordered a teaspoonful after 
each meal. I combined the fever syrup in this prescription, 
for the purpose of giving tone to the bowels and restraining 
diarrhoea. 

I have treated several other cases of a similar kind with 
the same flattering success — cases which were originally of 
the true catarrhal kind, and also those having a malarial 
origin, in scrofulous constitutions. 

NATURAL DEFECTS. 

Children are often born with some part of the body lack- 
ing. Some of these omissions of nature are incompatible 
with life, as the want of a head, or of the heart, etc. But 
other defects, as the absence of a limb, will not prevent the 
child from living. Occasionally the natural openings of the 
body are imperforate, and may be remedied by an operation. 
I have seen several instances in which the urinary orifice 
was closed, and required the use of the lancet. A more 
serious case occurred to'me some years since, in which there 
was no external opening to the bowels. As I reported this 
case, with my manner of operating, and its success, to the 
Nashville Journal of Medicine and Surgery, I will take the 
liberty of transcribing it. 

Prof. Bowling : In the June number of your Journal I 



902 MIDWIFERY. 

find an interesting case of imperforate anus, reported by 
Prof. Buchanan ; and, as such cases are not of very frequent 
occurrence in this country, I have concluded to give you a 
short account of one which occurred in my practice a few 
years since, which differed in some of „ its features from the 
one which he reported. 

I w T as first called to see the case when the child was 
about ten days old. Upon examination, I found no mark 
indicating where the anus should have been. All was round 
and smooth — no indentation between the nates ; but imme- 
diately under the scrotum there was a small opening, into 
which I could insert a common probe, and through which 
a little of the most fluid contents of the bowels had exuded. 
This opening, I suppose, had existed at the birth, and, by 
giving vent to enough of the coloring matter of the fseces to 
stain the cloth, had prevented the nurse from noticing the 
condition of things until the child was more than a week 
old. A neighboring physician was immediately called in, 
who gave a decided dose of calomel, I suppose with a view 
of forcing a larger opening. The child grew rapidly worse 
under this treatment, and I was finally sent for. 

I attempted to reach the bowel by a probe introduced 
through the small opening above named, but could not suc- 
ceed, owing to its tortuous course, and was, therefore, wholly 
unable to determine how much of the bowel was lacking. 
But, as the child was now vomiting stercoraceous matter, 
and I believed imminently threatened with convulsions, I 
resolved on an immediate attempt to procure an opening as 
the only possible means of saving it. I accordingly selected 
the part where I believed the anus should have been, and 
proceeded to operate with a common scalpel. I proceeded 
cautiously, lest I might wound an artery, not knowing what 
other malformations might exist ; but after cutting to the 
depth of about an inch and a half, I had the pleasure of 
reaching the closed end of the bowel, which, not waiting to 
be cut, was torn open by the spasmodic contraction of the 
abdominal muscles, and the contents were projected horizon- 
tally across the room, striking the opposite wall, and barely 
giving me time to remove my head from their line of march. 



DISEASES PECULIAR TO INFANTS. 903 

How much good the calomel exhibited did in preparing it 
for this easy ejection I do not know. 

The little sufferer was now completely relieved ; but it 
required a good deal of warm brandy toddy to prevent it 
from sinking from the effects of so sudden a removal of the 
stimulus of distention. After reaction was once established, 
it required no further general treatment. I used a conical 
roll of linen, kept in place by the T bandage, to prevent 
adhesion, to be removed every time a discharge from the 
bowels was indicated by the motions of the child. 

On the next Sunday the matrons of the neighborhood 
met, and held a consultation over the case, and decided that 
I had made the hole in the wrong place, and dispatched the 
father after me to come and do my work over. He accord- 
ingly followed me to church, and called me out. I told him 
he might rest easy on that subject ; but, as he informed me 
that a partial closing of the opening had taken place, I 
w T ent with him home. I now enlarged it, and directed the 
means to be continued as before directed. 

In two or three weeks afterward I was again called on to 
see the case. I found the vent sufficient to admit the pass- 
age of tolerably liquid stools, but offering obstruction to 
them when somewhat hardened. I now enlarged the inci- 
sion to something like an inch, and directed the bougie to be 
discontinued, but to strictly apply the bandage, depending 
upon the pressure of the faeces to keep the opening from 
closing. To further this end, I directed that the bandage 
should not be removed until the child showed by its strain- 
ing that the contents were fully in the artificial opening. 
This plan succeeded finely, and I had no further trouble 
with the case : in a month or two all care was discontinued. 

Two years afterward I was called to deliver the mother 
of another child, and made an examination. Every thing 
looked as natural as if no malformation had ever existed. 
The little opening under the scrotum closed soon after the 
operation was performed — the sphincter acted efficiently. 
He is now a fine boy of six years old, the pride of his 
father. 



904 MATERIA MEDIOA. 



MATERIA MEDIOA. 



We cannot be expected to give a history of all the reme- 
dies which have gained reputation in the cure of disease, or 
even all that have been prescribed in this work ; but we 
will present a sufficient number of indigenous medicinal 
herbs to enable our readers to always find something at hand 
to answer the purpose when those most relied on may not 
be easily obtained, or from frequent use, or any other cause, 
fail in producing their usual effect. 

After this chapter on indigenous remedies, we will con- 
clude by giving a chapter of formulas, or recipes, in which 
all the compounds recommended in this work, as well as a 
number of others, will be given, with the mode of using 
them, etc. 

AGRIMONY, Agrimonia — Grows two or three feet high, 
in hedges and the margins of fields ; blossoms in July, on 
long spikes, yellow. It is known by the vulgar name of 
cuckold, from the seeds sticking to the clothes in the fall of 
the year. 

In whey or tea, it forms a good drink in fevers. The 
juice of this plant, or a strong infusion of the roots, two 
handfuls to a quart of boiling water, and sweetened with 
honey, is said to be an excellent medicine in the jaundice, 
scurvy, and chronic diarrhoea. I know it to be good in 
cankerous sore mouth. Dose of the infusion, half a pint ; 
of the juice, a wineglassful three times a day. 

ALDER, BLACK, Alnus Nigra — Sometimes called Vir- 



MATERIA MEDICA. 905 

ginia Winterberry, grows in most places, generally sending 
up several slender stalks to the height of ten feet, and bears 
a red berry. 

The bark is tonic, and accordingly is used in substance, 
or in strong decoction, like the Peruvian bark, in interinit- 
tents and other cases of debility, as dropsy, gangrene, etc. 
The inner bark in the shape of poultice externally, with the 
decoction internally, a handful or two boiled slowly in three 
pints of water to a quart, is celebrated both by Professor 
Bartpn and Dr. Mease as of admirable use in arresting the 
pi ogress of mortification. A strong decoction of the berries 
formed into a syrup with molasses, in doses of a wineglass- 
ful, or two teaspoonfuls of the powder of the inner bark, is 
said to be a good purge. 

Dr. Thatcher recommends a decoction or infusion of the 
bark, taken internally in doses of a teacupful, and employed 
also as a wash, for the cure of cutaneous eruptions, particu- 
larly of the herpetic kind. 

ALUM ROOT, Heuchera Americana — Called also Ameri- 
can Sanicle. The root is a very intense astringent. It is the 
basis of a powder which has lately acquired some reputation 
in the cure of cancer. Professor Barton observes that he 
does not believe that the alum root has cured genuine can- 
cer; but that it has proved very beneficial in obstinate 
ulcers, which have been mistaken for cancers. He says it 
is one of the articles in the Materia Medica of our Indians, 
the powdered root of which they apply to wounds, ulcers, 
and cancers. 

ANGELICA, Angelica — Grows in marshy woods and 
hedges, flowering in June and July. It is frequently culti- 
vated in our gardens. 

Every part of this useful vegetable partakes of its aro- 
matic virtues, but especially the root, which, in the form of 
powder, tincture, or tea, is useful in flatulent colics. Con- 
joined with dogwood bark, or any other tonic, it may, like 
the Peruvian bark, be employed with advantage in intermit- 
tents and low stages of fever. The dose, one teaspoonful 
in substance of the former to two of the latter. It may 



906 MATERIA MEDICA. 

also be employed in the form of strong decoction, in doses 
of a gill, or, in cold phlegmatic habits, in tincture, either 
alone, or with dogwood berries, centaury, lemon peel, or 
any other article of the bitter and tonic class. A strong 
decoction of the root, combined with red oak bark, a large 
handful of each to a pint of boiling water, makes an admira- 
ble gargle for relaxed and spongy gums, and ulcerated sore 
throat. 

APPLE, PERU. See Thorn Apple. 

ARBUTUS. See Bearlerry. 

ARROW ROOT, Maranta Arundinacea — Is cultivated in 
the Southern States. A tablespoonful makes a pint of the 
finest jelly in nature, which affords the most nutritious food 
in acute diseases for children. To persons laboring under 
bowel complaints, as diarrhoea and dysentery, it is of itself 
a remedy. 

The jelly is made in the following manner : To a table- 
spoonful of the powdered root add as much cold water as 
will make it into a thin paste, and then pour on boiling 
water through the spout of a kettle, stirring it at the same 
time briskly till it becomes a clear jelly ; after which, sea- 
son it with sugar and nutmeg, and, to render it still more 
palatable, a little wine or lemon-juice may be added. But, 
for children, blending it with new milk is best. 

ASARABACCA SWAMP, Asarum— Grows in low-lands. 
It has but two leaves, which rise immediately from the root, 
and divide from one stem. The flowers are purple and 
bell-shaped, and proceed from between the leaves. 

The whole of this plant has a nauseous, bitter taste. 
The root, from a half to a tablespoonful in powder, operates 
both upwards and downwards. In the form of infusion, a 
half handful to a quart of boiling water is said to be ser- 
viceable in the whooping-cough, in doses of a tablespoonful 
to children every half hour, or oftener, until it vomits ; and 
in doses of a teacupful three times a day, it has been used 
with success to promote the menses, or courses. 

AVENS COMMON, Geum Urbanum— Grows a foot high 
by fences and borders of fields. The blossoms are white or 
yellowish in July. Its smell resembles that of cloves. 



MATERIA MEDICA. 907 

A strong tincture of the root, two handfuls, steeped in a 
quart of spirits, given to the quantity of a half wineglass- 
ful, or the powder, in doses of a teaspoonful several times 
a day. has afforded an excellent remedy in intermittents 
and other disorders where strengthening medicines are 
requisite. 

There is another variety of this plant, called water avens, 
Chi oat root, cure-all, which is to be found in boggy meadows. 
The blossoms are purplish, and appear in May. Its proper- 
ties are the same as the preceding. A decoction of it has 
been found beneficial as a gargle in ulcerated sore throats, 
which probably gave rise to the name of throat root or throat 
wort. 

BALM, Melissa Officinalis — -Makes an excellent tea in 
fevers ; and when sweetened, and acidulated with the juice 
of lemons or cream of tartar, forms a most grateful beverage. 

BARBERRY, Berberis Vulgaris — Grows along the sides 
of roads in hedges ; leaves oblong, tender, and subject to 
the rust ; the flowers are in clusters ; the fruit oblong and 
acid ; the stem is defended by three thorns. 

A double-handful of the berries, boiled in three quarts of 
water to two, and given in doses of a teacupful four or five 
times a day, sweetened with white sugar, is extolled as a 
remedy in diarrhoea, dysentery, and jaundice. 

BAYBERRY, Myrica Cerifera Humilis — Called also 
Dwarf Candlebury Myrtle ; grows in swamps to the height 
of two or three feet, and bears numerous green berries, of 
which tallow is made. 

The inner bark, in poultice, applied morning and evening 
to scrofulous swellings, and drinking a teacupful of a strong 
infusion of the leaves, is said to have wrought surprising 
cures in a few weeks. 

BEARBERRY,ilr^to TJva JJrsi — Bears whortleberry — 
wild cranberry. Is a low evergreen shrub, somewhat re- 
sembling the myrtle. 

The leaves have a bitter astringent taste, and unquestion- 
ably possess medical virtues, especially in relieving the 
irritation of the stone, or gravel. 

The dose : half a pint twice or thrice a day of a decoc- 



908 MATERIA MEDICA. 

tion made of the leaves, a handful to a pint, or a teaspoon 
ful in substance two or three times a dav. 

BEECH DROPS. See Broomrape Virginia. 

BENNE, Se Samum Orientale — Is now cultivated in 
South Carolina and Georgia. The leaves, by infusion, 
afford an excellent mucilaginous drink, which is used with 
manifest advantage in dysentery, diarrhoea, and cholera 
infantum. 

The seeds yield a pure and pleasant oil, which, in doses 
of from one to two w T ineglassfuls, acts well on the bowels. 

BITTER-SWEET. See Nightshade, Wood?/. 

BLACKBERRY, or DEWBERRY— These, though dif- 
ferent in name, are nearly, if not entirely, the same in 
nature. They both bear the same kind of berry, which, 
when ripe, is pleasant and wholesome. 

The roots of these vines, but especially of the dewberry, 
are famous as astringents. From my own observation in 
practice, two handfuls of the clear root in three pints of 
milk or water boiled to a quart, and given in doses of a tea- 
cupful every two or three hours, have often cured obstinate 
diarrhoeas. 

BLACK SNAKE ROOT. See Virginia Snake Boot. 

BLAZING STAR. See Devil's Bit. 

BLOOD ROOT, Sangninaria Canadensis — Has a variety 
of names, as Red Root, Puccoon, Indian Paint, Turmeric. 
It grows about a foot high in rich woodlands, and flowers 
in April. The leaves are roundish and deeply indented, 
somewhat like the white oak leaves — steins naked, support- 
ing single flowers ; blossoms white. When the fresh root, 
which is about the size of the little finger, and blood red, is 
broken, a juice issues in large drops resembling blood. 

The root in powder, from twenty to thirty grains, is 
strongly emetic. Professor Barton considers it nearly 
equal to the Seneca or rattle-snake root in cases of ulcerous 
sore throat, croup and hives, and other similar affections. 
Professor Dexter exhibits it in doses of one grain of the 
powdered root, or ten drops of the tincture, every two or 
three hours, as an excellent diaphoretic in colds, or pleu- 
risies, rheumatism, and other inflammatory complaints. 




BLOODROOT. (Sauguinaria Canadensis.) 




CALAMUS. 




BEARBERRY. {Uva Ursa) 



MATERIA MEDIC A. 909 

A tincture may be prepared by steeping a handful of the 
root sliced in half a pint of spirits. It may also be exhi- 
bited in the form of decoction, a handful to a quart of 
boiling water, and a tablespoonful for a dose every two or 
three hours. The juice of the root is said to be good for 
destroying warts. 

BONE-SET. See Thoroughwort. 

BROOMRAPE VIRGINIA, Orobanche Virginiana— 
Grows from Canada to Georgia, and rises six or eight 
inches high, of a brown color, brittle sprigs, but no leaves ; 
the root is bulbous. It is generally found under the shade 
of the American beech tree ; hence it is sometimes called 
beech drops, but more generally cancer root. 

Every part of this plant is considerably astringent, and 
along with the astringency, especially in the recent plant, 
there is combined a peculiar and extremely nauseous bitter- 
ness. It has been celebrated as a remedy in dysentery, 
but its principal reputation is in cancerous affections. 

It is certain, says Professor Barton, that the powder 
of cancer root has been of great service, externally applied 
to obstinate ulcers, some of which had resisted all the 
ordinary applications. The fresh bruised root has also been 
applied with good effects to cancerous sores. In the form 
of decoction it has been found useful as a wash to gallings 
in warm weather, or excoriation of the skin. It is also 
esteemed a good application in cases of St. Anthony's Fire. 

BURDOCK, Arctium Lappa — Grows on the roadside, 
on rubbish and ditch banks, bearing purplish blossoms in 
July and August. 

The juice of the fresh leaves, or an infusion or decoction 
of the roots, operates gently on the bowels. This is sup- 
posed to be a good blood-purifier, and is much used for that 
purpose. The juice is given in doses of a wine-glassful, 
Und the decoction half a pint three times a day. 

CALIMUS, or SWEET FLAG, Acorus Oalimus— 
Grows in marshy situations, and in shallow water, and may 
be known by the long sword-shaped leaves, resembling 
those of the blue and yellow flags, but narrower, and of a 
bright green. The root is like that of the blue flag in 



910 MATERIA MEDICA. 

appearance, but has a strong aromatic smell, and a warm 
pungent taste. The flavor is greatly improved by drying. 

The root possesses stomach virtues, and is frequently 
grated into water, and given to children for flatulent colics, 
free of fever. It is sometimes used as an ingredient with 
dogwood, cheny bark, centaury, etc., in morning bitters, as 
a preventive of the ague in low marshy situations. 

CAMOMILE, Chamoemelum — Grows well in our gardens. 
An infusion, or tea, made of the flowers, is excellent to 
warm and strengthen the stomach in cases of indigestion, 
loss of appetite, and other complaints arising from debility. 
It is also of great use in doses of a teacupful three times a 
day, as a preventive of the ague and fever, and bilious fever 
in sickly situations. In the form of fomentation and poul- 
tice it is serviceable in discussing hard tumors. 

CAMOMILE, WILD. See Mai/weed. 

CANCER ROOT. See Broomrape Virginia. 

CANDLE-BERRY MYRTLE. See Baylerry. 

CARAWAY, Carum Carui — A choice aromatic; grows 
kindly in our gardens. The seeds assist digestion, strengthen 
the stomach, and are serviceable in flatulent colics. The 
dose of the seeds in powder, from one to two teaspoonfuls 
to adults. 

CARROT, WILD, Daueus Carato. — The wild carrot 
grows two or three feet high, and flowers in July. The 
seeds have an agreeable aromatic smell, and, in a slight de- 
gree, a warm, pungent taste. 

An ounce or half a handful of the seeds infused in a pint 
of water, and taken in doses of a teacupful every hour or 
two, is said to give immediate relief in suppression of urine, 
and is also serviceable in promoting the menses. 

The roots of the carrot cultivated in our gardens, beaten 
to a pulp, form an excellent application to cancerous and 
other ill-conditioned ulcers, allaying the. pain, checking the 
suppuration and foetid smell, and softening the callous 
edges. 

CASTOR OIL, Ricinus Communis — Flourishes well 
among us. The kernels yield almost a fourth part of their 
weight in oil, which is obtained from them either by ex- 



MATERIA MEDICA. 911 

pression or decoction. Expression is the best method of 
preparing ; but the common mode is to shell the seeds and 
boil them in water, and as the oil rises, to skim it off. 

Castor oil is a gentle and useful purgative. In doses of 
a teaspoonful, it is the most suitable purge, when not 
rancid, to expel the meconium from new-born infants. 

CENTAURY, Centaurium minor — Is a fine stomach 
bitter, and either in a simple infusion, or united with cali- 
mus or angelica root, is excellent in relaxations of the 
stomach and general debility. 

CHERRY TREE, WILD, Primus Cerasus Virginiana. — 
The bark of this tree is an excellent substitute for the 
Peruvian bark. I have myself frequently employed it in 
the cure of ague and fever, bilious fever, and other diseases 
where tonic medicines were proper. In intermittents of 
long standing, I have found it more efficacious when united 
with the Virginia snake root, in the proportion of one part 
of the latter to four of the former. It may be employed, 
either in powder or decoction, in the same doses as the 
Peruvian bark. A strong infusion of it in sound cider is 
said to be useful in the jaundice. A decoction of the bark 
will be found a good wash to ill-conditioned ulcers. The 
cherry of the tree, when ripe in autumn, is much used in 
the Southern States, for making bounce and cordial. The 
gum of the common cherry tree is a good substitute for the 
gum-arabic. 

CINQUEFOIL, Potentilla Reptans — Grows on pasture 
grounds, and is something similar to the strawberry. The 
stalks trail along the ground, and have but five leaves on 
each stalk, placed together, of an equal size, and bear a 
yellow flower. 

The whole of the plant, particularly the root, in the form 
of decoction, a handful to a quart of water or milk, boiled 
slowly, and sweetened with loaf sugar, is recommended as 
a remedy for the dysentery and bowel complaints. The 
dose for adults is a teacupful three or four times a day, and 
one-third or half the quantity for children. 

COLUMBO AMERICAN, Columba Americana— Grows 
plentifully in the Western country, in the vicinity of the 
58 



912 MATERIA MEDICA. 

Ohio river ; and, from abundant experiments, is found fully 
equal to the imported. , It has long been esteemed a power- 
ful antiseptic and tonic ; and, as such, has been employed 
with manifest advantage in gangrene, cholera morbus, bilious 
vomiting, bilious fever, indigestion, want of appetite, etc. 
It may be given in powder, in doses of a small teaspoonful 
every three or four hours, or in decoction, in doses of a tea- 
cupful. Two or three ounces of the root, steeped in a quart 
of spirits, form an excellent bitter, which, when taken in 
mint water, or infusion of orange peel, in doses of a table- 
spoonful, is excellent for moderating the retching in pregnant 
women. 

COMFREY, Consolida — Grows about two feet high, in 
moist situations near springs, but is cultivated in our gar- 
dens. The leaves are large, similar to water-dock, flowers 
of a pale blue color; the roots long, rather thicker than a 
man's finger, mucilaginous, and black externally, but white 
within. 

A handful of the roots boiled in milk, and given in doses 
of a teacupful three or four times a day, is a popular remedy 
in dysentery, bowel complaints, and the fluor albus, or 
whites. It is also beneficial as a diet drink in cases attended 
with a burning heat in making water. 

CORIANDER, Coriandrum — Is cultivated in our gardens. 
The seeds are warm, and of a pleasant flavor, and, in doses 
of a tea to a tablespoonful, have been found useful in cases 
of indigestion and flatulence. When mixed with senna, 
they more effectually correct the odor and taste of the in- 
fusion than any other aromatic. They also form an excel- 
lent addition to ingredients for bitters. 

CRANE'S BILL, Geranium Maculatum — Improperly 
called by some Crow Foot. It grows five or six inches 
high in meadows and woods ; has long, slender stalks, with 
seven long, narrow leaves at a joint. The root is generally 
crooked and knotted, blackish on the outside, and reddish ; 
has a rough taste, with an aromatic flavor. 

When applied externally, it is highly extolled for its 
styptic power in stopping hemorrhages of wounded vessels. 
The powdered root, in doses of a teaspoonful three or four 



MATERIA MEDICA. 91 



o 



times a day, or a decoction in milk, used as a common drink, 
is said to be excellent in checking immoderate menstrual 
discharges ; also the whites, gleet, and obstinate diarrhoea. 

CROW FOOT, Ranunculus Bulbosus — A very acrid plant, 
growing in meadows and fields. The leaves or roots bruised 
r.nd applied to any part of the body will soon raise a blis- 
ter, and ought to be used when the Spanish flies cannot be 
obtained. The roots, coEected in the fall, may be very well 
preserved through the winter by burying them in some fine 
dry sand. 

DANDELION, Leontodon Teraxacum — Vulgarly called 
piss-a-beds, grows in meadows, pastures, and on roadsides and 
ditch-banks, with yellow flowers, which blow from April to 
September, and possess the remarkable quality of expanding 
early in the morning, and closing in the evening. 

The root, leaves, and stalk, contain a large proportion of 
bitter, milky juice, which, in doses of a wineglassful twice 
or thrice a day, is good in chronic inflammations of the 
liver, dropsies, difficulty of making water, and other com- 
plaints arising from obstructions of the viscera. It may 
also be taken in the form of a strong decoction, from a gill 
to a half pint, twice or thrice a day. 

DEADLY NIGHTSHADE. See Nightshade, Deadly. 

DEVIL'S BIT, Veratrum Luteum. — The root of this plant 
is a very pungent bitter, and is employed as a tonic, either 
in the form of tincture or infusion. In this last form it has 
been employed as a vermifuge. 

DEWBERRY. See Blackberry. 

DILL, Anetheum Gravolens — Flourishes in our gardens, 
producing seed delightfully aromatic, which, in doses of one 
or two teaspoonfuls, is excellent to remove flatulent colics, 
and assist digestion. 

DOCK WATER, or WATER DOCK, Rumex Aquati- 
cus — Grows in wet ditches, mill-ponds, on sides of rivers, 
and in shallow water, flowering in July and August. 

Half a pint of a decoction of the leaves or roots, two 
handfuls to a quart of boiling water, or two or three tea- 
spoonfuls of the dried roots in powder, taken two or three 
times a day, is an admirable medicine to sweeten and purify 



914 MATERIA MEDICA. 

the blood in scurvy, scald-head, tetter-worm, and other cuta- 
neous diseases. The fresh roots bruised, and mixed with 
vinegar, or in strong decoction, are a good cure of the ring- 
worm, and have often subdued that filthy complaint, the 
itch, when quack medicines, and even sulphur, had failed. 
They are also worth trying, in the form of a poultice, to 
tumors and cancerous ulcers. 

The curled dock, narrow and broad-leaved dock, which grow 
in yards and cultivated fields, are all varieties of this useful 
plant, and possess similar virtues. It is said the narrow- 
leaved dock, applied in the form of fomentation and poultice, 
to a cancerous sore, and from a pint to a quart of the de- 
coction taken daily, has made cures. 

DOGWOOD, Cornus Florida. — The bark of this famous 
tree, which may well be termed the cinchona or Peruvian 
bark of North America, possesses, like that, all those tonic 
powers which give it such admirable control over intermit- 
tents, gangrene, and all diseases proceeding from debility. 

Like the Peruvian bark, but in somewhat larger doses, it 
may be used in substance or decoction, infusion or tincture, 
either alone or conjoined with snake root, or some of the 
aromatics. But the shape in which it will be found most 
agreeable is that of an extract, which is easily prepared by 
boiling the bark, straining it, and then evaporating it very 
slowly to the consistence of honey. To prevent the fatal 
effects of burning it, the vessel in which it is evaporated 
should be of the wide mouth sort, placed in a large pot of 
boiling water, and often stirred towards the close of the 
operation. 

The dose is from half to a whole teaspoonful, three or 
four times a day. The beautiful red berries of dogwood, 
combined with lemon peel, snake root, calimus, or any other 
warm aromatic seeds, form a fine bitter against the common 
fall complaints. 

ELDER, COMMON, or BLACK, Sambucus Niger — 
Grows to the height of a small tree,' in hedges, and along 
the border of meadows ; the young shoots are full of pith, 
and the old stalks empty ; flowers in July, and the berry 
is of a blackish purple color when ripe. 



MATERIA MEDICA. 915 

The expressed juice of elderberries put into a plate, or 
wide mouth vessel, and evaporated in the sun to the state 
of an extract, in doses from a tea to a tablespoonful, acts as 
a good aperient medicine. A tea made of the leaves, a large 
handful to a quart of boiling water, and taken freely, re- 
moves a costive habit, promotes perspiration, and thus proves 
useful in eruptions of the skin, St. Anthony's fire, colds, 
dropsies, and all obstructions of the viscera. The inner 
green bark, steeped in wine, a large handful to a pint, or 
made into a strong decoction, purges gently, in doses of a 
gill. The flowers, stewed with lard, form a good ointment 
for burns. 

ELECAMPANE, Inula Helineum — Grows three or four 
feet high, in stony pastures, and by the roadside ; flowers 
large and yellow, in July and August ; and the root, when 
dry, has an agreeable aromatic smell, and in a decoction 
sweetened with honey, or in the form of syrup, or a tea- 
spoonful of the powdered root in molasses, is recommended 
for promoting expectoration in asthma and coughs. The 
fresh root, in ointment or strong decoction, is said to cure 
the itch. 

ELM, AMERICAN, or SLIPPERY, Ulmus Americana— 
Steeped in water, it forms a cooling demulcent drink, very 
useful in febrile diseases ; and externally, as a poultice, in 
gun-shot wounds, tumors, and all ulcers and sores accom- 
panied with irritation. A teaspoonful of the inner bark in 
powder, to a quart of boiling water, or a simple infusion of 
the bark in boiling water, forms an astonishingly rich jelly, 
which I have often tried with the happiest effects in diar- 
rhoea and dysentery. With the addition of a little sugar, 
lemon-juice, citron, or nutmeg, it might be made an excel- 
lent substitute for sago or arrow-root. For its further uses, 
see Preparations of Slippery Elm, in the chapter on For- 
mulas. 

EMETIC WEED, or INDIAN TOBACCO, Lobelia 
Inflata — Grows in dry fields, and rises to the height of one 
or two feet, with branched stems, flowering in July and 
August, with blown cups, rilled with numerous small seeds. 



916 MATERIA MEDICA. 

The blossoms are solitary, in a kind of spike, of a pale blue 
color. The leaves are oblong, and have a very acrid and 
pungent taste, "similar to that of tobacco. 

The leaves collected in August, while the plant is in 
blossom, and carefully dried and preserved, act as a speedy 
and excellent emetic, in doses of from ten to twenty grains ; 
or it may be exhibited in the form of a saturated tincture, 
in doses from a tea to a tablespoonful. 

As it is a medicine of considerable activity, it should be 
given in small quantities, and the dose repeated every ten 
or fifteen minutes, until it excites vomiting. From its 
speedy operation as an emetic, it is useful in croup and 
whooping-cough. In small doses it is of great utility in 
consumptive and other coughs, by exciting expectoration. 
It is particularly valuable in asthma. 

ERGOT, or SPURRED RYE, Secale Cornutum.— 
Rye is subject to a disease, in low wet situations, or when 
a hot summer succeeds a rainy spring. The spurious sub- 
stance called ergot is found projecting from among the 
leaves of the spike or ear ; it is a long crooked excrescence, 
resembling the spur of a cock, pointed at the extremity, of 
a dark brown color externally, and white within. Some 
spikes are wholly occupied by spurs, while others have two 
or three only, interspersed with genuine seeds of rye. 

This extraordinary substance possesses considerable medi- 
cinal properties. In lingering and laborious cases in child- 
bed, it acts as an invaluable medicine, speedily inducing 
forcible pains, and expediting delivery. It is given in the 
form of powder, in doses of from five to thirty grains ; but 
it has sometimes been found more active in the form of 
decoction, prepared by gently boiling a drachm of the 
powder in half a pint of water, of which one-third may be 
taken every twenty minutes, until proper pains shall have 
commenced. 

It is proper, however, to caution the domestic practitioner 
against employing this powerful medicine. The powerful 
and continued efforts of the uterus, from the effects of the 
ergot, prevent the retreat of the child's head after being 



MATERIA MEDICA. 917 

advanced, and the unceasing pressure often occasions the 
death of the child. This medicine has also been success- 
fully employed in cases of obstructed menses. 

FEATHERFEW, Matricaria Vulgaris. — It is frequently 
cultivated in gardens. A handful of the leaves and tops 
infused in a quart of water, and given in doses of a teacup- 
ful three or four times a day, is used by country people to 
promote the menses, to strengthen the stomach, to raise the 
spirits, and promote perspiration in colds and fevers. 

FENNEL, SWEET, Fceniculum IM^— Grows kindly 
in our gardens. A teaspoonful of the seeds, with a little 
sugar and spirits, is a common remedy among the country 
people in flatulent colic. To children afflicted with the 
above complaint, an infusion of the seeds, sweetened, is 
highly serviceable. The seeds yield an aromatic oil, 
which, in doses of from two to twelve drops, removes flatu- 
lence, promotes expectoration, and is serviceable in coughs. 

FERN, FEMALE, or BACK-ACHE BRAKE — 
Grows near ponds, and in moist pastures, about twelve 
inches high. The leaves are single, winged, about a hand's 
length ; the root is about the size of a goose-quill, of a 
brown color, very sweet, and of a mucilaginous taste. 

A quart of a strong decoction of the roots, and a pint of 
honey, formed into a syrup by gentle simmering, and given 
in doses of a tablespoonful every hour or two, is esteemed 
highly beneficial in all violent coughs. It is said that three 
parts of the roots of this plant, and one part of sumach 
root, boiled slowly in any kind of spirits, until it becomes 
slimy, and then applied warm to the spine, has frequently 
relieved the back-ache ; hence the vulgar name back-ache 
brake. It has also been employed as a remedy for the 
rickets in children. 

FERN, MALE, Polypodium — Called also sweet fern, 
male polypody. It grows in woods and stony places, 
flowering from June to October. 

The root, when chewed, is somewhat mucilaginous an I 
sweet, and afterwards astringent and bitter. 

Sweet fern in powder, in doses of from one to two tea- 
spoonfuls, or a decoction, a pint a day, followed on the fifth 



918 MATERIA MEDICA. 

day by a dose of castor oil, or some purgative medicine, is 
esteemed a powerful medicine against worms, and particu- 
larly the tape-worm. 

FLAG, BLUE, or WATER FLAG, Iris Pseudacorus 
— Grows by the brink of rivers, in swamps and meadows, 
blossoming in July; flowers blue, variegated with white, 
yellow, and purple. 

The juice, in doses of a teaspoonful, diluted with water, 
is said to be an active cathartic medicine, and to produce 
copious evacuations from the bowels, and to be useful in 
dropsy. It produces similar effects in powder, from thirty 
to sixty grains, and has been employed as a vermifuge. In 
the form of decoction, used as a diet drink, it is greatly 
extolled in venereal cases. 

FLAG, SWEET. See Calimus. 

FLAX-SEED, Linum — Possesses great medicinal virtues. 
An infusion or tea is the most suitable drink for patients 
laboring under violent colds, coughs, difficulty or burning in 
making water. The flax-seed syrup, which is prepared by 
adding a pint of honey to a quart of strong tea, and simmer- 
ing it away slowly by a gentle fire for an hour, observing 
to take off the scum as it rises, is a most valuable medicine 
in diseases of the breast and lungs, in doses from a tea to a 
tablespoonful every hour or two, or oftener, when the 
cough is troublesome. The flax-seed bruised also forms 
one of the best emollient poultices with which we are 
acquainted. 

FOXGLOVE, Digitalis Purpurea — Has lately been culti- 
vated in our gardens. It rises to the height of two or more 
feet, and its leaves are large, egg-shaped, notched like a 
saw, and covered with hairs. Blossoms of a beautiful pur- 
ple color, hanging downwards in a row along one side, 
which are compared to the ringers of a glove, and in 
the inside are elegantly mottled with spots like little 
eyes. 

The foxglove has been employed with advantage in those 
disorders where the frequency of the pulse requires to be 
abated. In pleurisy and pneumonia, and the incipient 
stage of consumption, it has, by diminishing the circulation 



MATERIA MEDICA. 919 

through the lungs, frequently succeeded in arresting the 
progress of the disease. 

Foxglove possesses also diuretic power, and has long 
been employed in dropsy. It unquestionably acts power- 
fully as a diuretic, or in evacuating the water in dropsy. 
It should not be given in such doses as to excite much 
sickness or purge ; otherwise it will not produce its diuretic 
effect. The best rule for its administration is to commence 
with the smaller doses, twice or thrice a day, and gradually 
increase the quantity daily, until the medicine either act, on 
the kidneys, the stomach, or the bowels ; and on the first 
appearance of any of these effects, it is to be suspended. 

After evacuating the water, tonic or strengthening medi- 
cines should be employed. The leaves of this plant are the 
part in use, of which from one to three grains in powder 
may be given to an adult twice or thrice a day, alone, or 
united with some aromatic, or the powder may be formed 
into pills with soap, or the crumbs of bread, or it may be 
given in the form of infusion, by infusing a drachm of the 
dried leaves in half a pint of boiling water, for four hours, 
adding to the strained liquor one ounce of any good spirits ; 
from one to two tablespoonfuls to be given twice or thrice 
a day, as a medium dose for an adult. From twenty to 
sixty drops of the tincture may be taken in a little mint- 
water or tea two or three times a day. The medicine has 
also been externally applied with good effects. An infu- 
sion of it is recommended as a good wash for painful cuta- 
neous eruptions or ulcerations. An ointment prepared by 
simmering the leaves in lard or fresh butter, has been found 
successful in scrofulous ulcers and scald-head. 

GAELIC, COMMON, Allium Sativum— Is highly stimu- 
lating, and therefore useful to persons of cold, phlegmatic 
constitutions. It provokes the appetite, assists digestion, 
removes flatulence, promotes expectoration and urine, and 
hence has long been used in scurvy, asthma, and dropsy. 

Where it cannot be taken in substance, the best form is 
either in syrup or pills. Externally applied, it blisters the 
skin. A poultice or cataplasm of equal parts of bruised 
garlic and crumbs of bread, mixed with sharp vinegar, ap- 



920 



MATERIA MEDICA. 



plied to the soles of the feet, in the low stage of acute (lis 
orders, or nervous fever, is good to raise the pulse and 
relieve the head. Sydenham says it exceeds all other appli- 
cations for occasioning a revulsion from the head, and that 
the efficacy of garlic, thus applied every night until slight 
inflammation be produced, is superior to Spanish flies. It 
is an excellent remedy in cases of croup or violent sore 
throat. (See Onions.) 

It will also be found a good application to the pubes in 
producing a discharge of urine, when its retention has arisen 
from want of due action of the bladder. When made into 
an ointment, it is said to disperse cold and indolent tumors, 
and has been esteemed for its efficacy in cutaneous eruptions. 
In deafness, a small clove of the root, wrapped in gauze, 
cotton, or wool, moistened with the juice, and introduced 
into the ear, has frequently proved an efficacious remedy, 
if repeated twice or thrice a day. 

GENTIAN, Gentiana — Grows on the sides of roads and 
in waste pastures, two or three feet high. The stem is 
strong, smooth, and erect; the leaves, which rise from the 
lower part of the stem, are spear-shaped, large, ribbed, and 
rough; flowers yellow, in whorls, terminating in yellow 
bitter berries. 

Its virtues are equal to the imported. It has long occu- 
pied the first place in all recipes for bitters, whether used to 
provoke the appetite, or give tone to the system. It may 
also be taken in the form of infusion, a small handful of the 
root to a quart of boiling water, in doses of a teacupful 
three or four times a day. 

In the form of a decoction, it is used with decided advan- 
tage in pneumonia, where the fever is nervous : it acts as a 
tonic and sudorific ; a tincture of it is esteemed in dyspep- 
sia, given in doses of one-fourth or half an ounce. It is 
said to increase the appetite, prevent the acidification of the 
food, and to enable the stomach to bear and digest articles 
of diet which before produced oppression and dejection of 
spirits. 

GROUND HOLLY, Pyrola Umbettata. — It is sometimes 
called Pipsissewa, which is its Indian appellation. It pos- 







GENTIAN. {Gentiana lutea.) 




HEMLOCK. (Conium Maculatum.) 



MATERIA MEDICA. 921 

sesses in an eminent degree the same properties as Bear's 
Whortleberry, which see. 

HEMLOCK, Conium Maculatum — Grows to the height 
of six or seven feet, in rich land, near ditches, and in moist, 
shady places. It is an umbelliferous plant, with large leaves, 
of a dark green color on the upper side, and a whitish green 
underneath, much resembling parsley, especially the leaves 
of the smaller sorts, whose poisonous quality is the most 
violent. The stalk is round, smooth, hollow, and marked 
with brown or red spots ; the flowers are white ; the seeds 
greenish, flat on one side, very convex, and marked with 
five furrows on the other. The root is long, yellowish 
without, white and fungous within, and somewhat resembling 
a carrot. It changes its form according to the season ; and 
the leaves have a rank smell, resembling the urine of a cat, 
but do not much affect the taste. 

This poisonous plant possesses great medicinal virtue 
when judiciously employed. It has been used with con- 
siderable advantage in painful cancerous ulcers, venereal 
ulcerations, cutaneous affections, gleets, painful discharges 
from the vagina, and in a variety of cases of scrofulous 
affections. It has also been of great efficacy in epilepsy, 
chronic rheumatism, and jaundice. Externally applied, it 
has been useful in discussing scirrhous tumors, particularly 
those of a scrofulous nature. 

The proper method of administering hemlock inwardly is 
to begin with a grain or two of the powder of the leaves, 
or the inspissated juice, and gradually to increase the dose 
until the head is affected with slight giddiness, or it occa- 
sions some sickness, and trembling agitations of the body, 
or produces one or two evacuations the morning after the 
dose. One or more of these symptoms are the evidences 
of a full dose, and these continue until none of these effects 
are observed ; and then, after a few days, increase the dose, 
for little advantage can be expected but by a continuance 
of full doses. 

The dried leaves are less liable to injury from keeping 
than the inspissated juice. The leaves should be collected 
in June, when the plant is in flower, and its peculiar smell 



922 MATERIA MEDICA. 

strong. The drying of the leaves should be performed 
quickly before a fire, on tin plates. The proof of the drying 
having been well performed, is the powder's retaining the 
odor of the leaves, and the deepness and freshness of the 
color. It should be kept in close vials, and secluded from 
the light. 

HENBANE, BLACK, Hyoscyamus Niger — Grows at the 
sides of fences, about old ruins, and on dung-hills, and with 
the dung is sometimes carried into gardens, where, from its 
similitude to parsnips, it is mistaken for them ; and when 
eaten, produces stupor and apoplectic symptoms, terminating 
in death. It rises from one to two feet in height ; the stalks 
are thick, woody, irregularly branched, and covered with a 
hairy down ; the leaves surrounding the stalk at their base 
stand irregularly ; they are large, soft, and downy, pointed 
at the ends, and very deeply indented at the edges ; their 
color is a grayish green, and they hay e a disagreeable smell; 
the flowers are large, egg-shaped, and of a dirty yellowish 
color, with purple streaks. The root is long, tough, white, 
and when recently cut through, smells like liquorice. 

According to Dr. Stork, the juice of this poisonous plant 
inspissated, and exhibited in doses of from one grain to 
twenty every twenty-four hours, has relieved many from 
palpitation of the heart, a tendency to melancholy, coughs, 
and other spasmodic disorders and convulsions, and this after 
other means had failed. In my own practice, when com- 
bined with the oil of sassafras, it has proven to be one of 
the mildest and best anodynes and antispasmodics of which 
I have any knowledge. See Anodyne Alterant, in chapter 
on Formulas. 

HOPS, Humuli — Are an agreeable, strong bitter, princi- 
pally used in making malt liquors. They also induce sleep ; 
hence the popular remedy of a pillow of hops to procure 
sleep in the delirium of fever and insanity, which not un- 
frequently succeeds. They give out their virtues to spirits 
or water. 

In the form of fomentation and poultice, hops serve as a 
most valuable application to ill-conditioned ulcers, or painful 
cancerous sores. 




PINKROOT. (Spigelia Marilandica.) 




PURPLE FOX-GLOVE. {Digitalis purpurea.) 




BLACK HENBANE. {Hyoscyamus niger.) 



924 MATERIA MEDICA 

• 

once or twice a day, or it may be steeped in wine, an<? 
taken in doses of a small wineglassful. 

HOUSELEEK, Sempervivum — Grows on the roofs of 
houses and old walls, flowering in July. 

The juice of this plant, mixed ^with honey, is said to be 
of considerable service in the thrush of children. Stewed 
with cream, it is a great favorite with the country people 
for the cure of corns, fresh burns, stings of wasps, bees, and 
other external inflammations. An infusion of the leaves is 
also said to be cooling and laxative. 

HYSSOP, Isup Hyssopus — Is cultivated in our gardens. 
An infusion of the leaves, sweetened with honey, or in the 
form of syrup, is useful in humoral asthma, coughs, and 
other disorders of the breast and lungs, accompanied with 
inflammatory symptoms. 

INDIAN PHYSIC, or AMERICAN IPECACU- 
ANHA, Spirce Trifoleata — Grows about two or three feet 
high, in low woods and meadows. 

Professor Barton says the root, which is the part made 
use of, is a safe and efficacious emetic. 

In the dose of thirty to forty grains in powder, for an 
adult, it is one of the most safe and certain emetics. In 
broken doses of five or six grains, every two hours, it is 
equally valuable as a sudorific. It may also be given in 
infusion, a handful to a pint of boiling water, of which a 
small teacupful may be taken every fifteen or twenty 
minutes until it promotes vomiting. 

INDIAN TOBACCO. See Emetic Weed 

INDIAN TURNIP, Arum Maculaium — Wake robin. 
The leaves are generally bespangled with black and white 
spots, striped in gaudy style. The root is bulbous, resem- 
bling a small turnip. 

Both this and the leaves, in a fresh state, are extremely 
acrid, and have been used with advantage externally for 
blistering, and internally in cachexies, rheumatism, and all 
other complaints of cold phlegmatic habits. Of the fresh 
root, from ten to thirty grains may be taken thrice a day, 
in the form of emulsion, with gum-arabic, or cherry-tree 



MATERIA MEDICA. 925 

gum. The root, which should be used fresh, may be kept 
so for a year, by burying it in a cellar in sand. 

JAMESTOWN or JIMSON WEED. See Thorn 

JERUSALEM OAK, or WORM SEED, Chenopo- 
dium Anthelminticum — Has long been employed to expel 
worms. One or two teaspoonfuls of the seed, with molasses 
or honey, are generally given to a child two or three years 
old in the morning, on an empty stomach, and the dose is 
sometimes repeated at bed-time. It ought to be continued 
for several days. When there is an aversion to using it in 
this form, the seed may be boiled in milk, and taken in 
doses of one or two wineglassfuls, or the expressed juice 
of the plant, sweetened, may be exhibited in closes of a 
tablespoonful. The oil, which is prepared from the seed, 
possesses the same virtue, and is found a more convenient 
form of giving the medicine. , 

JUNIPER, COMMON, Juniperus Communis — An ever- 
green shrub, growing on dry barren commons, and hilly 
ground. 

A strong decoction, made of a handful of the tops and 
berries to a quart of boiling water, in doses of a teacupful 
three or four times a day, has long been employed in 
dropsy, scurvy, and gravel, or difficulty of urine. The oil 
of juniper possesses the same properties in a high degree, 
and imparts them to ardent spirits. The peculiar flavor 
and well-known diuretic effect of Holland gin are owing to 
this oil. 

Hoffman found it of great use in debility of the stomach 
and intestines, particularly in old people. The stronger 
preparations have been found useful in uterine obstructions, 
and in paralytic affections of the bladder. 

LEMON TREE, Citrus Medica — Is now cultivated in 
the Southern States, and holds the first place among the 
cooling and antiseptic vegetables to correct the putrid 
tendency of animal food in summer. 

The acid of lemon, from its antiseptic properties, has long 
been employed as a remedy in the scurvy. Lemon or lime- 



926 MATERIA MEDICA. 

juice, diluted with water, and the addition of a little sugar, 
forming lemonade, serves as one of the most grateful beve- 
rages in bilious and nervous fevers. The dried peel of 
lemons is a grateful aromatic, and as a stomachic generally 
constitutes one of the ingredients of bitters. 

LETTUCE, Lactuca Sativa. — The dried juice of the com- 
mon garden lettuce is found to be but little inferior in 
sedative power to opium. In those constitutions in which 
opium cannot be employed without producing very disagree- 
able consequences, we may safely employ the lactucarium 
or lettuce opium, or tincture. Many eminent physicians 
bear testimony to the good effects of this medicine in pro- 
curing sleep, in alleviating pain, and in allaying inordinate 
action, particularly a troublesome cough. And in no in- 
stance has it been found to produce nausea, costiveness, or 
irritation of the skin, which generally follows the use of 
opium or laudanum. 

The best method of obtaining the inspissated juice of 
lettuce in abundance is as follows : Let the ice-lettuce, 
which is considered best for this purpose, be planted in 
rows ; and when the top of the stem is about a foot above 
the ground, cut off about an inch from the top of each plant. 
The milky juice rises immediately above the wounded sur- 
face. But it is better to cut off the tops of all the plants 
before you begin to collect. After having done this, begin 
to collect the milky juice by means of a wet sponge, where 
the incision was first made, and as you go along, cut off a 
thin cross slice from the stem of each plant, leaving fresh 
wounds. After going round the plants five or six times in 
the way mentioned, they will cease to yield any more 
milky juice at that time. But this process maybe repeated 
two or three times in a day. The milky juice collected in 
this way is to be expressed into a teacup or any similar 
vessel. It soon acquires a dark brown color, like opium 
obtained from the poppy ; has all its other sensible qualities ; 
and hence it may justly be distinguished by the title of 
lettuce opium. 

It may be administered in the form of pills, in doses from 



MATERIA MEDICA. 927 

one to two grains. The tincture is prepared by adding one 
ounce of the extract to a pint of spirits, which may be given 
in doses of a teaspoonful. 

LICHEN, or LUNGWORT, Lichen— Is a thin shell or 
skin which grows on the bark of the white oak tree, resem- 
bling the lungs, from whence it is called lungwort. 

It is said to possess the same qualities as the Iceland 
moss, or lichen, so celebrated in the cure of consumption. 

An infusion, a handful to a quart of boiling water, used 
as a common drink, or a strong decoction formed into syrup, 
with honey or sugar, may be taken in doses of a wine- 
glassful three or four times a day. It is also said to be a 
useful medicine in the whooping-cough. 

MADDER, WILD, Rubia Tindorum — Is cultivated in 
Pennsylvania and South Carolina for dyeing a fine red 
color, but also possesses great medical powers. 

It has been highly recommended in visceral obstructions, 
particularly of the uterus, in coagulations of the blood 
induced either by falls or bruises, in dropsical complaints, 
and especially in the rickets. It may be given in powder 
from five to fifteen grains to children, and from a half to a 
whole drachm three or four times a day to adults. When 
taken internally, it possesses the remarkable quality of 
tinging the urine of a red color, and produces similar effects 
on the bones of animals, when eaten with their food. 

MAGNOLIA — Goes by several names, as beaver-tree, 
swamp sassafras, elk bark, Indian bark. It is an agreeable 
aromatic tonic bitter medicine. 

An infusion or decoction of the bark has been used in 
the ague and fever, and is much celebrated among the 
western Indians as a remedy in rheumatism. I am informed, 
from a respectable source, that John Dickinson, Esq., author 
of the celebrated Pennsylvania Farmer's Letters, was com- 
pletely cured of a violent attack of the chronic rheumatism 
by a strong decoction of the twigs of the magnolia. 

The species Magnolia Grandiflora, evergreen laurel, some- 
times called tulip tree, grows to the height of eighty feet 
near Savannah. The bark of the root of this tree is also 

used as a substitute for Peruvian bark in intermittent 
59 



928 MATERIA MEDICA. 

fevers. The cones or seed-vessels of the magnolia, which 
is commonly called cucumber tree, have been advantageously 
used in Virginia, in the form of tincture, in rheumatic com- 
plaints. 

MAIDEN HAIR, Asplenium Trichomanes — Called also 
milk-waste, spleenwort — Grows on old walls, rocks, and 
shady stony places, generally to the height of seven or 
eight inches ; leaves very fine and soft, and spotted under- 
neath ; stalks of a dark purple color ; flowers from May to 
October. Its leaves have a mucilaginous sweetish taste, 
without any peculiar odor. 

An infusion, by pouring a quart of boiling water on a 
handful of the dry herb, sweetened with honey, and taken 
in the quantity of a teacupful every hour or two, or a 
spoonful in the form of syrup, is said to be good in tickling 
coughs, hoarseness, and disorders of the breast, proceeding 
from acrid humors in irregularities of the menses, and 
obstructions of the viscera. 

MALE FERN. See Fern, Male. 

MALLOW, COMMON, Malva Sylvestris— Grows in 
hedges, footpaths, and among rubbish ; flowering from June 
to August. The leaves possess a mucilaginous sourish 
taste. 

A decoction of this plant is said to be useful in dysenteries 
and gravel complaints, though it is chiefly employed as an 
emollient poultice to produce suppuration. 

MANDRAKE, or MAY-APPLE, Podophyllum Pelta- 
tum — Grows on low grounds, two or three feet high, leaves 
generally three, broad at the base, and terminating in a 
sharp point ; flowers yellow ; the fruit resembling a lime, or 
a small yellow apple, and is much admired by some. 

The root is an excellent purgative, and may be taken in 
doses from ten to thirty grains in substance, or double 
the quantity infused in a gill of water. 

The best time of gathering the mandrake, for medicinal 
purposes, is in autumn, when the leaves have turned 
yellow and are about falling off. The Indians dry it in the 
shade, and powder it for use. 

MARSH MALLOW, Althcea Officinalis — Grows in 




MAY APPLE. {Podophyllum Peltatum.) 





RUE. (Ruta Graveolens.) 



DANDELION (Dens Leonis.) 



MATERIA MEDICA. 929 

marshes and wet places. The leaves have a soft woolly 
surface, feeling like velvet. The flowers are of a white 
pale flesh color, and appear in August. 

Every part of the marsh mallow, and especially the root, 
when boiled, yields a copious mucilage, on account of which 
it is employed in emollient cataplasms or poultices, for 
softening and maturing hard tumors. It is likewise of 
eminent service in the form of infusion in asthma, hoarse- 
ness, dysentery, and gravel. 

MAY-APPLE. See Mandrake. 

MAY-WEED, or WILD CAMOMILE, Dog Fennel 
— Grows about two feet high, in pastures near fences ; the 
flowers are yellow, resembling camomile flowers, and are 
frequently used as a substitute for them. 

MEZEREON, Daphne Mezereum — Called also spurge 
laurel, dwarf bay. Grows plentifully in woods and shady 
places near the Ohio, and flowers in the month of February 
or March. The fruit is a berry, in which is found a single 
seed. The leaves are spear-shaped, and the flowers grow 
of a beautiful red or rose color. 

The bark of the root of this plant is the part used in 
medicine, and has an extremely acrid burning taste in the 
mouth and fauces. 

Dr. Withering asserts, that a patient who lived under 
extreme difficulty of swallowing for three years, was effect- 
ually cured in two months, by chewing the root as often 
as she could support its irritating effects. The fresh root, 
scraped and applied to the surface of the skin, affords an 
efficacious blister ; when taken internally, it determines to 
the surface, and has been found greatly serviceable in rheu- 
matism and obstinate cutaneous diseases. Its principal use, 
however, is in the venereal disease, in the last stage, or 
when mercury has failed. It is particularly efficacious in 
relieving nocturnal pains, and removing venereal nodes. 
One gill to a half pint of the decoction, made of two 
drachms, or a handful of the bark, with an equal quantity 
of liqtorice root, boiled in three pints of water to a quart, 
may be taken three or four times a day. 

MOTHERWORT, Leonuriis Cardiaca — Grows in waste 



930 MATERIA MEDICA. 

places, and flowers in July and August. The flowers are 
in thorny whorls, purplish within, and white on the outside ; 
the leaves are opposite, two to each whorl; they have a 
strong disagreeable odor, and bitter taste. 

An infusion of this plant is a common domestic medicine 
in fainting and disorders of the stomach. It is said to be 
peculiarly adapted to some constitutions affected with ner- 
vous and hysterical agitations ; and that, if taken at bed- 
time, it procures refreshing sleep, when opium and laudanum 
have failed. 

MUGWORT, or COMMON WORMWOOD, Artemisia 
Absinthium — Grows two or three feet high, on roadsides and 
among rubbish; leaves deeply divided, pointed; on the 
upper side of a deep green, and on the under soft and 
downy ; flowers small and purplish. 

An infusion, a handful of the tops to a quart of boiling 
water, in doses of a teacupful, or a teaspoonful of the pow- 
dered leaves, three or four times a day, is an admirable 
stomachic in weakness of the stomach, lowness of spirits, 
and hysterical affections. It is also said to be a useful 
medicine in difficult menstruation, in intermittents, jaundice, 
and dropsical affections. Externally, it is applied in the 
form of fomentation and poultice, to resist putrefaction and 
relieve the pains of bruises, as well as prevent the swelling 
and discoloration of the part. 

MULBERRY TREE, Moms Nigra et Alia.— lis fruit 
has the common quality of all other sweet fruits, quenching 
thirst, abating heat, and proving laxative in its effects. 

A syrup made of the juice of the fruit serves as an ex- 
cellent gargle for mitigating inflammations of the throat and 
ulcers of the mouth. 

The bark of the root of the black mulberry tree, in doses 
of thirty grains, or half a teaspoonful of the powder, or 
double the quantity infused in a gill or half a pint of boiling 
water, or equal parts of a strong decoction and molasses, 
formed into a syrup, in doses of a wineglassful, is an excel- 
lent purgative, and has been used with success as a termi- 
fuge, particularly for the tapeworm. 



MATERIA MEDICA. 931 

MULLEN, Verlascwn. — The leaves, a handful to a quart 
of milk, are a common remedy in bowel complaints. 

In the form of fomentation or poultice, it is employed to 
relieve the piles, and other painful swellings ; and in a dry 
and pulverized state, to destroy fungous or proud flesh. 

MUSTARD, BLACK AND WHITE, Sinapis Nigra et 
Alba. — Mustard used with our food provokes the appetite, 
assists digestion, and promotes the fluid secretions, and is 
especially adapted to persons of weak stomachs, or where 
much acid prevails, as it acts upon the system generally 
without producing much heat. 

A tablespoonful of prepared mustard in a pint of warm 
water, on an empty stomach, operates as an emetic. A 
tablespoonful of the unbruised seed, taken twice or thrice a 
day, proves a gentle laxative, increases the urinary dis- 
charges, and is useful in chronic rheumatism, asthma, palsy, 
and dropsy. 

In languid constitutions, or low stages of fevers, a gill of 
the seeds mixed with a small handful of horse-radish, and 
infused in a quart of wine, in doses of a wineglassful, occa- 
sionally, is a most cordial stimulant. 

Another excellent form in which mustard may be taken 
is that of whey. It is prepared by boiling two or three 
tablespoonfuls of the seeds bruised, in half a pint of milk, 
and as much water, till the curd be perfectly separated, to 
which a little sugar may be added ; and of this drink, a tea- 
cupful may be taken three or four times a day, in nervous 
fevers. 

The powder of the seeds, mixed with crumbs of bread 
or flour, and formed into a poultice with sharp vinegar, is 
an excellent application to the parts affected with rheuma- 
tism, and to the soles of the feet and palms of the hands 
in fevers, where there is a languid circulation, or cold ex- 
tremities, or in cases of delirium. 

NIGHTSHADE, AMERICAN. See Polceweed. 

NIGHTSHADE, DEADLY, Atropa Belladonna— -Grows 
two or three feet high, in hedges, among rubbish, and in un- 
cultivated places ; flowers dusky brown on the outside, and 
a dull purple within, appearing single among the leaves in 



932 MATERIA MEDICA. 

June or July ; the berries round, green, changing to red, 
and, when ripe, of shining black. The whole of this plant 
is poisonous, and children, allured by its beautiful berries, 
have too often experienced their fatal effects. 

Like all other strong poisons, in the hands of skill it 
performs wonderful cures in palsy, epilepsy, melancholy, 
jaundice, dropsy, and cancer. In the employment of this 
dangerous medicine, it is necessary to begin with very small 
doses. Half a grain of the powdered leaves or root, or two 
teaspoonfuls of the infusion, prepared by infusing twenty 
grains in half a pint of boiling water, and strained after 
cooling, is a sufficient dose for adults to commence with. 
The dose is to be gradually increased, and repeated daily; 
but as soon as any dangerous symptoms occur, its use ought 
to be suspended for some days, and afterwards resumed in 
smaller doses. Externally, the powdered leaves are applied 
to mitigate the pain in cancerous and other ill-conditioned 
ulcers, and the leaves, in the form of poultice, to discuss 
scirrhous and cancerous tumors. 

The garden nightshade, growing also on dung-hills, with 
white flowers, odor of musk, and the berries, when ripe, of 
a shining black, possesses virtues similar to those of the 
deadly nightshade. 

From one to three grains of dried leaves infused in boil- 
ing water, and taken at bed-time, will generally induce a 
copious perspiration, increase the discharge of urine, and 
operate as a mild laxative on the following day. If, after 
increasing the dose, some visible effect be not produced, its 
further use will not avail much. The dose is to be repeated 
every night, or every other night. In the form of poultice, 
it has abated the inflammation of the eyes, painful swellings, 
and inflammation of the venereal kind, and scrofulous and 
cancerous tumors. 

The woody nightshade, called also bitter-sweet, because it 
is first sweet and then bitter, grows on the sides of ditches 
and in moist hedges, climbing upon the bushes with wind- 
ing, woody, but brittle stalks. The flowers are in clusters, 
of a blue purple color, appear in June or July, and always 
turning against the sun. The berries are red. 



MATERIA MEDICA. 933 

This species is not so deleterious as the above two, and 
it acts more uniformly. Its sensible operation as a medi- 
cine is also by sweat, urine, and stool, and, in the form of 
infusion, is said to be eminently serviceable in acute rheuma- 
tism. It has also been found efficacious in jaundice, scurvy, 
obstructions of the menses, and in obstinate cutaneous dis- 
orders. An infusion is prepared by adding a pint of boiling 
water to an ounce or half a handful of the twigs or stalks, 
either in a fresh or dried state, of which a teacupful or more 
may be taken morning and evening. Another form is made 
by steeping four ounces of the twigs in a pint of wine, the 
dose a wineglassful. In the form of poultice or cataplasm 
it is also said to be a powerful discutient of hard tumors. 
For this purpose, boil two or three handfuls of the leaves 
in wine or vinegar, to which may be added a little flaxseed, 
and this to be applied warm to indurated or hard tumors. 
The application of the juice and leaves to cancerous sores 
is said, in some instances, to have performed a cure. 

OAK, Quercus — The bark of the oak possesses, in a con- 
siderable degree, astringent, tonic, and antiseptic properties. 
Hence, we can never be at a loss for means in those dis- 
eases which call for a remedy possessing these properties ; 
as diarrhoea from debility and relaxation, a weakening dis- 
charge from the vagina, etc. It also forms an excellent ap- 
plication for flabby and ill-conditioned sores and ulcers. 

ONIONS, Allium Cepa — Possess similar virtues with the 
garlic, only in a less degree. The disagreeable smell which 
they impart to the breath may be effectually obviated by 
eating a few leaves of parsley immediately after the onions. 

When well borne by the stomach, onions eaten raw have 
a most happy effect in many cases of nervous debility fol- 
lowing acute diseases. 

Roasted onions form one of the very best applications 
for sore throat, mumps, swelling from decayed teeth, earache, 
and local inflammations generally. 

ORANGE TREE, Citrus Aurantium — Is now cultivated 
in the Southern States, and deservedly esteemed for its 
grateful acrid juice, which, by quenching thirst and dimin- 
ishing heat, is of considerable use in febrile disorders. From 



/ 

934 MATERIA MEDICA. 

its virtues to resist putrescency, it has always, and most 
deservedly, held the first place on the list of antiscorbutics. 

PEACH TREE, AmygdaluB Persica. — Both the flowers 
and leaves are excellent cathartics, and ought to be pre- 
served by every family. A teaspoonful of a strong infu- 
sion, sweetened, and taken every hour or two, will operate 
mildly on the bowels, without griping, as senna does. Of 
the syrup, prepared by boiling slowly the juice of the 
leaves with nearly an equal quantity of molasses, honey, or 
sugar, a teaspoonful to children, and a wineglassful to adults, 
will also prove a mild laxative medicine. 

But peach leaves are not only laxative ; they also possess 
considerable anodyne properties, and perhaps some other 
property beside these, by which they control inflamma- 
tion and irritation of the bowels in dysentery. See Comp. 
Peach-leaf Syrup, under the head of Dysentery. 

A decoction, prepared by boiling a handful of the dried 
leaves in a quart of water to a pint and a half, and taken 
in doses of a teacupful every two or three hours, is reputed 
to have proved an effectual remedy in gravel and voiding 
blood by urine, which had resisted the usual remedies. 

PENNYROYAL, Mentha Pulegium. — An infusion, a hand- 
ful to a quart of boiling water, the dose a teacupful three 
times a day, has long been esteemed in hysteric complaints 
and obstructions of the menses. 

PEPPERMINT, Mentha Piperita — Is an excellent sto- 
machic in flatulent colics, hysteric cases, and vomiting. 
The usual modes of administering it are infusion, the dis- 
tilled water, and the essential oil. The last, united with 
rectified spirits of wine, forms the essence of peppermint, 
so highly esteemed. 

In nausea, cholera morbus, obstinate vomiting, and grip- 
ing, peppermint, infused in spirits, and applied, as hot as 
can be endured, to the stomach and bowels, will be a most 
valuable remedy. 

PEPPER, RED, or CAYENNE, ' Capsicum Annum— Is 
cultivated in our gardens ; it is a powerful stimulant, and 
has been found beneficial in chronic rheumatism. Those 
who are subject to flatulence will find benefit in using it 



MATERIA MEDICA. 935 

with vegetables and soup. In case of violent pain or cramp 
in the stomach, no medicine is superior to a strong infusion 
of red pepper, one or two pods to a half pint of spirits, in 
doses of from a half to a wineglassful. It is also useful, 
both as a medicine and gargle, in putrid sore throat, when 
infused in water. Steeped in spirits, applied warm to the 
extremities in chronic rheumatism, or low stages of nervous 
fever, when the circulation is languid, it has produced the 
most happy effects. 

No other remedy has acted so well in my practice, for 
allaying a tickling, harassing cough, whether from cold or 
asthma, as a weak infusion of red pepper in cold water. 
Most persons make it too strong, and then it is apt to occa- 
sion dryness ; but taken weak, and especially when sweet- 
ened with honey, it creates moisture and aids expectoration, 
and wonderfully soothes the irritation which keeps up the 
cough. 

PINK HOOT, CAROLINA, Spigelia Marylandica — 
Grows abundantly in the Southern States, and is deservedly 
esteemed a vermifuge , or destroyer of worms. An infusion, 
a handful to a quart of boiling water, and one or two tea- 
cupfuls night and morning, is the usual form and dose. 
With the addition of milk and sugar, children will take it 
almost as readily as their tea. It sometimes occasions dis- 
agreeable affections of the eyes ; when this occurs, suspend 
the use of the medicine until these symptoms disappear, 
and then select from another parcel, or make tea jof the tops 
only, as it is supposed the deleterious effects are in conse- 
quence of some other root being attached to it. 

Pink root is always considered a valuable medicine in 
fevers, as is verified daily, when given to children in a feb- 
rile state for a vermifuge, when no other effect has been 
produced than a removal of the fever. 

PLANTAIN, Plantago — Has long been employed as an 
antidote against the bites of snakes, of spiders, and other ven- 
omous insects. The juice, when extracted from the whole 
of the plant, is generally given in doses of two tablespoon- 
fuls every hour, or oftener, until the patient is relieved. 
It is sometimes given in conjunction with horehound or rue. 



936 MATEKIA MEDICA. 

The leaves, bruised, are considered by some a good applica- 
tion to fresh wounds. 

PLEURISY ROOT, Asclepias Decumbens — Has a variety 
of names, as butterfly weed, flux root, decumbent swallow- 
wort. It is a beautiful plant, growing two or three feet 
high, under fences and upland pastures. The flowers are 
of a bright orange color, and appear in July and August. 
These are succeeded by long slender pods, containing the 
seed, which have a delicate kind of seed attached to them. 
The root is spindle or carrot-shaped, of a light brownish 
color on the outside, white within. 

This plant possesses great medicinal virtues, and ought, 
therefore, to be cultivated in our gardens. It has long been 
employed as a remedy in the treatment of violent cold and 
pleurisies. No medicine is better calculated than this to 
produce general and plentiful perspiration without heating 
the body, and hence its well-merited fame in curing the dis- 
ease whose name it bears. 

It is usually given in infusion, a handful to a quart of 
boiling water, and a teacupful given every hour or two. 

POISON OAK, Rhus Toxicodendron — Embraces several 
species, the most dangerous of which is the swamp sumach. 
The poison may be communicated, not only by the touch, 
but also by the smoke, smell, or steam, producing an erup- 
tion on the skin, with pain and itching, and sometimes at- 
tended with swollen head and fever. The best remedies 
which have come under my notice are, lime water exter- 
nally, and salts internally. 

POKE WEED, Phytolacca Decandra — Is known by a 
variety of names, as American nightshade, coacum, garget, 
skoke. The berries, steeped in spirits, have long been em- 
ployed in chronic rheumatism. It has, however, sometimes 
failed, which may have been owing to peculiarity of consti- 
tution, or to the inertness of the bounce or tincture from 
age, an effect often observed by Professor Barton. From 
the authority of this learned professor, the juice of the ripe 
berries, inspissated to the state of an extract, and spread 
upon a rag, or upon a leaf of the plant, is an excellent ap- 
plication to scrofulous or indolent tumors. The juice of the 




CAMOMILE. (Anthemis.) 




POKE WEED. {Phytolacca decandra.) 



MATERIA MEDICA. 937 

leaves has been applied in the same manner, with equal ad- 
vantage. An ointment of the leaves, with lard, is good in 
various kinds of ulcers. The roots, bruised, are sometimes 
applied to the hands and feet of the patients in fevers. 

To make an extract, expose to moderate and continued 
heat the juice of the berries or leaves, until, by evaporation, 
it thickens to the consistency of honey. It may also be 
made from the root, which is equally efficacious. Boil the 
roots for some time, strain the decoction, and then reboil it 
to a thick consistency. 

An infusion of the leaves is recommended externally as 
an admirable remedy for the piles. 

The usual form of exhibition is the bounce, a wineglass- 
ful three times a day. The bounce is prepared by filling a 
jug with the whole berries when ripe, and then pouring as 
much spirits on them as the vessel will contain. 

An ointment, prepared by simmering slowly the leaves, 
or a handful of the root scraped in a pint of hog's lard, with 
a small portion of beeswax, has been used with reputed 
success in cancers, and various kinds of ulcers. 

POMEGRANATE, Punka— Is cultivated in the South- 
ern gardens. The fruit is agreeable to the palate, and pos- 
sesses the properties of subacid fruits. Its rind, boiled in 
milk, and drunk freely, or in powder, a teaspoonful three 
times a day, has been used with success in diarrhoeas, dys- 
enteries, and other diseases requiring astringent medicines. 
The flowers possess the virtues of the rind, only in a less 
degree. 

POPLAR TREE, or WHITE WOOD, Liriodendrum Tu- 
lipifera. — The bark of this noble tree, as well as the root, 
is an aromatic bitter. 

In intermittents, in the last stage of dysentery, and other 
disorders requiring tonic medicines, it is considered but 
little inferior to the Peruvian bark, and is generally em- 
ployed in similar doses and forms. 

There is another species of poplar, the aspen tree, popur 
his tremula, the bark of which, according to Professor Bar- 
ton, is also an excellent tonic and stomachic. 



938 MATERIA MEDICA. 

POPPY, WHITE, Palaver Somniferum — Grows in om 
gardens, and yields a juice which, when inspissated to a 
proper consistence, is called opium. 

Poppy heads are used externally in fomentations and 
poultices, either alone or conjoined with the leaves of South- 
ern wood, camomile flowers, or other ingredients. 

POTATO, SWEET, Convolvulus Batatas.— From this 
root Bowen's patent sago is prepared, which forms a very 
nutritious jelly, like arrow-root, and is prepared in the same 
manner, to which the reader is referred. 

The process generally used for procuring the powder of 
the sweet potato is to grate the clean roots, wash the mass 
through brass sieves of different sizes, and collect the flour 
at the bottom of the vessel which receives the fluid ; finally, 
dry it in pans either by the fire or in the sun. 

POTATO, WILD, Convolvulus Panduratus — Grows in 
low grounds and sandy soils, near running water. It trails 
along the ground several feet, much like a grape vine, the 
root very large, hard, and white, running deep in the earth ; 
the leaves triangular, the flowers whitish, with a purple 
tinge, and bell-shaped. It is called wild rhubarb, and is 
employed as a purgative in doses from a tea to a table- 
spoonful of the powdered root. Professor Barton says that 
the root, in powder or decoction, has been much recom- 
mended in Virginia, and other parts of the United States, 
in cases of gravel. The decoction is prepared by boiling 
slowly a handful of the root, sliced or bruised, in three 
pints of water to a quart, of which, in gravel complaints, 
a teacupful may be taken four or five times a day. Boiled 
in sweet milk, it has the reputation of curing dysentery. 

PRICKLY ASH, AND PRICKLY YELLOW WOOD, 
Zanthoxylum — Possesses the same virtues. Both species 
are covered with numerous prickles, whence the name. 
Both the bark and berry are of a hot acrid taste, and, when 
chewed, powerfully promote spittle. It is used in this way 
to cure the toothache; also to cure' the palsy of the tongue. 

The prickly ash has a great deal of reputation as a 
remedy in chronic rheumatism. In that disease its opera- 



MATERIA MEDICA. 939 

fcion seems nearly analogous to that of Mezereon and Guaia- 
cum, which it nearly resembles in its sensible properties. 
It is most frequently given in decoction ; an ounce being 
boiled in about a quart of water. 

A tincture prepared by steeping half a pint of the berries, 
or a handful of the bark, in a bottle of spirits, is much 
esteemed as a remedy in flatulent colic. It is sometimes 
employed in this form, in cold phlegmatic habits, afflicted 
with rheumatism. 

PRIDE OF INDIA OR CHINA, Melia Azcdarach— 
Is now completely naturalized to the Southern States. 
Independently of its luxuriant verdure and cooling shade, 
it is highly valuable for its medicinal properties, being now 
ascertained to be one of the best vermifuges. 

Many physicians in the Southern States have witnessed 
its remarkable effects in destroying and dislodging worms. 
It has even been found a remedy against the tape-worm. 

The common modes of using this medicine are the infu- 
sion or tea, and saturated decoction. Of the former, a 
handful of the bark to a quart of boiling water is given in 
doses of a small teacupful morning and night. The decoc- 
tion is made by boiling a large handful of the fresh bark of 
the root in three pints of water to a quart, which is given' 
to children in doses from a half to a whole wineglassful. 
Dr. Kollock, of Savannah, observes, when exhibited in the 
latter form, every three hours, until it operates, he has 
found it beneficial as a febrifuge in those affections usually 
denominated worm fevers, but where no worms are voided. 
The pulp which invests the stone of the fruit, pounded with 
tallow, has been successfully employed in cases of scald-head. 

PUCCOON. See Blood Root. 

QUEEN OF THE MEADOWS— Grows in hedges, and 
on the sides of meadows, about four feet high ; in very rich 
bottoms, however, it grows much higher than this ; the 
stalk reddish, leaves long, spear-shaped, and opposite each 
other, flowers purple. 

A large handful of the roots boiled in three pints of 
water to a quart, and given in doses of a teacupful every 
two hours, is said to be an excellent remedy in suppression 



940 MATERIA MEDICA. 

of urine, and for carrying off the water in dropsy. Ar 
infusion of the leaves or stalk forms an admirably pleasant 
cooling drink in fevers, and excites perspiration. 

RASPBERRY, Idaus — Like the rest of the rich sub- 
acid fruit, when ripe, the raspberry is wholesome and 
nourishing. Raspberries, as well as strawberries, held in the 
mouth, will dissolve tartarous concretions formed on the teeth. 

RED CEDAR, Juniperus Virginiana — Is found from 
Lake Champlain to the Cape of Florida. The leaves have 
a strong disagreeable taste, with some pungency and bitter- 
ness. Its most frequent use is in the composition of the 
cerate employed for keeping up the irritation and discharge 
of blisters. This preparation is the same with the savin 
cerate used in Europe, the leaves of the red cedar being 
substituted for the savin. When properly prepared by 
boiling the fresh leaves for a short time in about twice their 
weight of lard, with the addition of a little wax, a cerate is 
formed, of peculiar efficacy as a perpetual epispastic. 
When applied as a dressing to a new vesicated surface, and 
afterwards repeated twice a day, it rarely fails to keep up 
the discharge for an indefinite length of time. Under its 
operation, the discharge usually changes from a serous to a 
puriform appearance, and concretes upon the surface ; so 
that it requires to be removed from time to time, to admit 
the full action of the cerate. 

Internally, the leaves have been found to exert effects 
very similar to those of the savin. They have proved use- 
ful as an emmenagogue, and as a general stimulant and 
diaphoretic in rheumatism. They have also had some repu- 
tation as a diuretic in dropsy. 

ROSE, Rosa. — The hundred-leaved, or damask rose, is 
justly termed the queen of flowers. Otto or essence of 
roses is obtained from these by distillation, and is doubt- 
less the most elegant perfume in vegetable nature. Inde- 
pendently of their use in this manner, a decoction of its 
leaves will be found a mild laxative, and, when formed into 
a syrup, may be given with advantage to children. The 
conserve of roses is also prepared from them for medicinal 
purposes. 



MATERIA MEDICA. 941 

RUE, Ruta — Has an ungrateful smell, and a pungent 
bitter taste. The leaves are acrid, and when applied to the 
skin are apt to produce blisters. Employed in the form of 
tea, they are reputed to be of great service to persons of 
cold phlegmatic habits. According to Boerhaave, an infu- 
sion of the leaves powerfully promotes perspiration, quickens 
the circulation, removes obstructions, and is particularly 
adapted to weak and hysterical constitutions, suffering from 
retarded or obstructed secretions. 

SAGE, Salvia. — An infusion of the leaves, or tea, is con- 
sidered serviceable to persons of cold phlegmatic habits 
laboring under nervous debihty. Sweetened with the addi- 
tion of a little lemon juice, it forms an exceedingly grateful 
and useful drink in febrile disorders. 

SARSAPARILLA, Smilax Sarsaparilla — Grows in 
several parts of the United States. • It is a small vine 
resembling a bramble. 

A decoction of sarsaparilla, prepared by boiling a large 
handful of the root in a quart of water till the third part be 
evaporated, has long been employed as an auxiliary to 
mercury in the treatment of venereal complaints. It pro- 
motes perspiration, attenuates viscid humors, relieves 
venereal headache, nocturnal pains, and disposes venereal 
ulcers to heal. In rheumatic affections, cutaneous disorders, 
and scrofula, it is a very useful medicine. It may also be 
exhibited in the form of powder in doses of two drachms, 
or extract in doses of one drachm, three or four times 
a day. 

SASSAFRAS, Laurus Sassafras. — An infusion or tea of 
the flowers or bark of the root has often been successfully 
given as a sweetener or purifier of the blood, in scorbutic, 
venereal, and cutaneous disorders, or where an acrimony of 
the fluids prevails. Conjoined with bark of dogwood, cherry 
tree, or oak, it is very useful in obstinate intermittents. 
The oil externally applied in chronic rheumatism, and also 
in wens, has oftentimes proved salutary. The pith of the 
small twigs, in water, forms a mucilage of excellent use for 
sore eyes, and as an injection in the incipient stage of 
gonorrhoea. It also affords, when sweetened, with the 



942 MATEEIA MEDICA. 

addition of nutmeg, a palatable jelly, useful in dysentery 
and febrile diseases. But besides these properties, which 
are about all that are enumerated in standard works, the 
sassafras, as the reader who has perused this work already 
knows, possesses other and more valuable curative powers, 
which have placed it, in the author's estimation, in the first 
class of remedies. It does not appear to act especially 
upon any of the organs of secretion, but it gently stimu- 
lates all into increased healthy action ; it probably does this 
by promoting a more vigorous nervous influence. It is also 
a good blood-purifier ; is anti-narcotic— that is, it controls or 
modifies the action of narcotic vegetable substances, so as 
to prevent their unpleasant effects, especially of tobacco 
and /hyoscyamus ; it is also exceedingly destructive to 
insect life ; and housewives will be glad to learn that the 
oil applied to the joints of a bedstead will effectually clear 
it of chinches or bed-bugs ; applied in this way every month 
or two, it will keep them off, though the walls of the tene- 
ment may be ever so badly infested with them. 

SCURVY GRASS, Cochlearia Officinalis — Is a pungent, 
stimulating plant, and in the simple state of a salad, or in 
the form of expressed juice, a wineglassful three times a 
day, has long been esteemed one of the best of all the anti- 
scorbutic plants. 

SENEKA SNAKE ROOT, Poly gala Senega— (how* 
nearly a foot high, the leaves pointed, and somewhat oval ; 
the stalks upright and branched, the flowers white, the root 
variously bent and jointed, and supposed to resemble the 
tail of the animal whose name it bears. 

In violent colds, croup, pleurisy, acute rheumatism, and 
all inflammatory complaints, I can recommend it as an 
admirable medicine to promote perspiration. The best form 
of using it is in decoction, a handful to a quart of water, a 
wineglassful to adults every two or three hours, increasing 
or lessening the quantity to avoid vomiting and purging. 

Professor Chapman recommends it very highly in obstruc- 
tions of the menses ; four ounces of the decoction to be 
taken in the course of the day, increasing the quantity when 
the menstrual effort is expected, as far as the stomach will 




BLACK SNAKEROOT. 
{A ristolochia Serflentaria.) 









SENECA SNAKEROOT. 
{Poly gala Senega.) 




DEADLY NIGHTSHADE. (A tropa Belladonna.) 



MATERIA MEDICA. 943 

allow. If this excite nausea, aromatics are to be added, as 
cinnamon, calimus, and angelica. 

Dr. Archer, of Harford county, Maryland, was among 
the first who noticed the efficacy of this medicine in cases 
of croup or hives. 

He directs a teaspoonful of the strong decoction to be 
given to a child every hour or half hour, as the urgency of 
the symptoms may demand, and, during the intervals, a 
few drops occasionally, until it acts as an emetic or cathartic ; 
then repeat in small quantities, to keep up a constant 
stimulus in the mouth and throat. Patients who use this 
medicine should not be permitted to drink any thing what- 
ever for some time after each dose. He employed it in the 
form of powder in doses of four or five grains, mixed with a 
little water. 

In various forms of dropsy, the seneka root has been 
resorted to with advantage, and has received the commenda- 
tions of Percival, Millman, and some others. Its cathartic 
and diuretic effects are very considerable, when persevered 
in, in large quantities ; and have, in many instances, effected 
the dissipation of dropsical swellings. In epidemic influenza, 
a decoction of this vegetable, taken freely at the commence- 
ment of the disease, is a medicine of great utility. 

SENNA, AMERICAN, Cassia Marylandica — Is easily 
cultivated from the seeds, and ought to be more generally 
introduced into our gardens. 

It has long been employed as a purgative. To increase 
its effects on the bowels, manna, salts, or tamarinds, are 
generally added. To correct its ill flavor, and prevent 
griping, it should be joined with some aromatics, as cori- 
ander or fennel seed, ginger, etc. In the form of decoction, 
a handful to a pint of boiling water, the dose is a teacupful 
every hour or two until it operates. It may also be exhi- 
bited in the form of tincture, to relieve flatulent colics, four 
ounces of senna to a quart of spirits, with an ounce of 
coriander seed, or ginger, and a wineglassful the dose. 

SORREL, Oxalis Acetosella — Called also sour trefoil, or 
cuckoo bread; yields, on expression, a grateful acid juice, 
60 



944 MATERIA MEDICA. 

which has been beneficially used in the scurvy and scorbutic 
eruptions. An infusion of the leaves makes a palatable diet 
drink in fevers, and, on being boiled in milk, forms an agree- 
able whey. A conserve made of the leaves, with double 
their weight of loaf sugar, forms an excellent substitute for 
lemons, and may be given with advantage in all putrid and 
other fevers where antiseptics are indicated. The leaves 
bruised, and externally applied to scrofulous ulcers, have 
produced excellent effects by promoting suppuration and 
granulation. 

SOUTH- SEA TEA, OR YAUPON, Alex Vomotoria— 
Grows abundantly in the Southern States. It rises about 
twelve feet high, shooting into many upright, slender, stiff 
branches, covered with whitish smooth bark; the leaves 
small, evergreen, and saw-edged; the flowers small and 
white, and grow promiscuously among the leaves, succeeded 
by small berries, which become red in October, and remain 
so all the winter. 

It is held in great esteem among the Southern Indians. 
They toast the leaves and make a decoction of them, which 
is called black-drink. 

An infusion or tea of the leaves is considered as palatable 
as Bohea tea, and when used freely is a powerful diuretic, 
and hence of service in the cure of dropsy and suppression 
of urine. 

SUMACH, COMMON, Rhus Copallmum.— -The berries or 
seeds, when ripe, are red and very acid. An infusion of 
them, sweetened with honey, is a good gargle for the sore 
throat, and for cleansing the mouth in putrid fevers. 

As a poultice, it is valuable for cleansing foul ulcers. It 
also has considerable reputation as a diet drink in scrofulous 
and syphilitic diseases. It is said that the juice of the 
berries will dissolve calculi. 

TANSY, Tanacetum Vulgar e. — This plant possesses a 
warm, bitter taste, and may be used as a substitute for 
hops. An infusion of the leaves ' is recommended for a 
weak stomach, hysteric complaints, and obstructed menses. 

According to Dr. Withering, its seeds are an excellent 



MATERIA MEDICA. 945 

vermifuge, in doses from a scruple to a drachm, and, if 
animal substance be rubbed with the herb, it will be effect- 
ually preserved from the flesh fly. 

THORN APPLE, Datura Stramonium — Has a variety of 
names, as Jamestown or Jimson weed, French apple, Stink 
weed, etc. Its common name, Jamestown weed, is said to 
have arisen from the circumstance of a number of sailors 
being violently diseased by ignorantly eating the boiled 
plant at Jamestown, in Virginia, at its first settlement. It 
grows among rubbish and on dung-hills, to the height of 
two or three feet ; flowers in July and August. The corolla 
is funnel-shaped, and plated white, with a tinge of purple. 
The capsule is large, egg-shaped, and covered with thorns, 
which have four divisions, and contain numerous kidney- 
shaped seeds. The leaves are large, egg-shapecl, and deeply 
indented, of a disagreeable smell and nauseous taste. 

Every part of this plant is a strong narcotic poison. 
Nevertheless, when judiciously administered, it is unques- 
tionably one. of the most valuable medicines in our posses- 
sion. Professor Barton considers it a medicine of great and 
invaluable powers, especially in cases of mania, attended 
with little or no fever, or with a cold skin and languid circu- 
lation. The form in which he exhibited it was of an extract 
prepared from the fresh leaves, beginning with a few grains, 
and gradually increasing the dose to fifteen or twenty 
grains. 

The extract may be made by exposing the juice of the 
plant to the heat of the sun, or by boiling the bruised seed 
or leaves in water for the space of four hours ; then strain 
off the liquor, evaporate over a gentle tire, without taking 
off the scum, until it has acquired the thickness of syrup ; 
then place it in a warm oven, in an earthen vessel, until it 
becomes of a proper consistence for use. The dose is from 
one to two grains, or more, for an adult. The saturated 
tincture is prepared by steeping one or two handfuls of the 
leaves in a half pint of spirits for a few days. 

The stramonium has also been employed externally with 
the most happy effects. In recent wounds, inflammations, 
or bruises, the leaves, either alone or united with bread 



946 MATERIA MEDICA. 

and milk poultice, have been applied to the part with mani- 
fest advantage. In the form of ointment, which is prepared 
by simmering slowly the fresh leaves bruised in hog's lard, 
with about one-eighth part of beeswax, for an hour, and 
then strained through a coarse cloth, it will be found excel- 
lent for the piles, scalds, and burns. From my own observa- 
tion, it far excels all other applications I have made to 
obstinate cutaneous sores, ill-conditioned ulcers, and painful 
cancerous affections. 

THOROUGTTWORT, Eupatormm Perforatum— Is known 
also by the following names : thoroughstem, crosswort, bone- 
set, and Indian sage. The first of these names, thorough- 
stem, has been imposed upon it from the peculiar structure 
of the leaves, which are opposite, and appear as though the 
stem were thrust through them. It has received the second 
name, of crosswort, by which it is known in many parts of 
Virginia, from the position of the leaves, each pair of which 
take their organ from opposite sides of the stem, so that 
they cross each other nearly at right-angles. I am at a loss, 
says Professor Barton, to refer the word boneset to its real 
origin ; but I presume the plant received this name from 
the great relief which, on many occasions, it has been found 
to afford to persons laboring under violent remitting and 
other fevers in which the bones are greatly pained. The 
resemblance of the leaves of this plant to those of the com- 
mon sage was long ago remarked by the botanists. Hence 
the name Indian sage, by which the eupatorium is known 
in some parts of Pennsylvania. 

This plant flourishes in wet meadows and other moist 
places. The stalk is hairy, and rises from two to four feet. 
The flowers are white, and appear in July and August. 
The leaves at each joint are horizontal, saw-edged, and rough, 
from three to four inches long, and about two inches broad at 
the base, gradually lessening to a very acute point, of a dark 
green, and covered with short hairs. 

This plant possesses very active powers, and has been 
exhibited with uncommon advantage in intermittents, remit- 
tents, and other diseases of debility. When exhibited in 
the form of a warm decoction, a handful of the herb boiled 




BONESET. (Eupatorium perfoliatum.) 




THORN APPLE. {Datura Stramonium.) 



MATERIA MEDICA. 947 

in a quart of water, a wineglassful every two hours, has 
proved 'peculiarly beneficial, says Professor Barton, in fevers, 
by exciting a copious perspiration. In larger doses, it proves 
emetic, with which view it is used in some parts of the 
United States as an excellent remedy in intermittents. The 
dried leaves in powder, in doses of twelve to fifteen grains, 
are said to operate gently on the bowels. Every part of 
this plant may be advantageously employed in practice. 
The flowers, as a tonic bitter, are deemed equal to the flow- 
ers of camomile, for which they might be substituted on 
many occasions. 

THYME, GARDEN, Thymus Vulgaris— Is one of the most 
powerful aromatic plants, and, as such, is frequently employed 
in the form of tea in those complaints where the medicines 
of this class are indicated. 

TOBACCO, Nicotiana Tobacum. — This " obnoxious lux- 
ury" is a medicine of the most uncommon powers, being 
emetic, cathartic, sudorific, diuretic, expectorant, narcotic, 
and anti-spasmodic; hence its utility in a variety of dis- 
eases. 

Happy if this plant " of many virtues" could always be 
devoted to beneficent purposes, for which, no doubt, it 
was intended by the all-wise and benevolent Creator. But 
alas ! we are constrained to deplore not only the idle and 
expensive, but too often fatal abuse of it, by snuffing, chew- 
ing, and smoking practices, which cannot be too severely 
censured, especially in young persons, and those of weak 
digestion, consumptive or delicate habits. When used in 
either of these forms, by persons unaccustomed to its use, 
it will, in small quantities, produce stupor, giddiness, and 
vomiting ; but, like spirits, opium, and other narcotics, the 
use of it may be introduced by degrees, so that its pecu- 
liar effects, even from large quantities employed, seldom 
appear. 

VALERIAN, WILD, Valeriana Officinalis — Grows abun- 
dantly in the vicinity of the Ohio river. It rises two or 
three feet high ; the leaves in pairs, large, hairy, and of a 
dusky green color ; flowers stand in large tufts on the top 
of the branches, of a pale whitish-red color. 



948 MATERIA MEDICA. 

The root, which is the part used in medicine, consists oi 
a number of slender fibres, matted together, and attached 
to one head, of a brown color, having a strong and unplea- 
sant smell. Valeria has long been recommended as a medi- 
cine of great use in nervous disorders, and is particularly 
serviceable in hysteric cases, as well as in epilepsy, pro- 
ceeding from a debility of the nervous system. According 
to Dr. Withering, it is an excellent medicine in cases of 
habitual costiveness. It should be given in doses from one 
to two teacupfuls or more, or in powder, three times a day. 
It seems most useful when given in substance, and in large 
doses 

VIRGINIA, OR BLACK SNAKE ROOT, Serpentaria 
Virginiana — -Grows in rich woodlands, from seven to nine 
inches high, leaves heart-shaped, flowers of purplish brown 
color. The root is composed of a number of strings, or 
fibres, issuing from one head, and matted together, of a 
brownish color on the outside, and pale or yellowish within. 

It has an aromatic smell, and a warm, bitterish, pungent 
taste. It promotes perspiration, raises the pulse, and re- 
sists putrefaction. Hence, it is especially adapted to the 
low and advanced stage of typhus or nervous fever. It may 
be given in the form of infusion or tea, a handful to a quart 
of boiling water, in doses of a teacupful; or in powder, 
from ten to thirty grains every two or three hours. Con- 
joined with the Peruvian bark, or any of its substitutes, it 
is an admirable remedy in obstinate cases of the ague and 
fever, and other disorders of general weakness. In cold 
phlegmatic habits, it has also been exhibited in the form of 
tincture, and when united with double the quantity of dog- 
wood bark, or berries, it affords a good bitter. Professor 
Barton observes, that a strong decoction of the root was 
used with great benefit as a gargle in a putrid sore throat 
which prevailed in New Jersey. 

WALNUT, WHITE, or BUTTERNUT— Affords one of 
the finest cathartic medicines in the whole American Mate- 
ria Medica. The inner bark, boiled for several hours, then 
strained and re-boiled to the consistence of thick honey, 
forms the best preparation of this invaluable medicine. A 



MATERIA MEDICA. 949 

common-sized pill or two at going to bed is admirable to 
remove those costive habits which occasion headaches, load- 
ed stomachs, colics, etc. And in increased doses, say double 
quantities, it will be found a sovereign medicine in dysen- 
tery, bilious fever, and all other complaints requiring aperi- 
ent medicines, more especially if combined with equal quan- 
tities of calomel. 

WILLOW, Salix. — Professor Barton thinks that our wil- 
lows possess nearly the same virtues that have been ascribed 
to those of Europe, and that they might be substituted for 
the Peruvian bark. The bark of the white willow, smooth 
willow, and crack willow — so called from the remarkable 
brittleness of its branches — collected when it abounds with 
sap, has been successfully employed in intermittent or ague 
and fever, in doses of one or two drachms. The broad- 
leaved willow is said to possess greater virtues than either 
of the above. This species may be distinguished by the 
shape of its leaves from all others except the bay-leafed 
willow. The leaves of the latter are smooth and shining, 
of a deeper green, and have not the downy appearance on 
the under surface which is so remarkable in this. It is 
found in woods and hedges, on hilly situations, and delights 
in cold, clayey, moist grounds. 

A strong decoction of this bark resembles port wine in 
color. It is astringent to the taste, and somewhat bitter. 
According to Dr. Wilkinson, it is a remedy of great efficacy 
in most cases where the Peruvian bark is indicated. He 
directs one ounce and a half (a handful) of the bark to be 
infused in one quart of water for six hours, then boil it over 
a gentle fire for a quarter of an hour, and strain for use. 
Of this, the ordinary dose is a wineglassful three or four 
times a day. But in ague and fever, the dose may be re- 
peated every third hour in the interval of the fit. 

YARROW — Grows in dry pastures and along the sides 
of fences, about a foot high ; leaves pointed ; flowers white, 
tinged with a little purple beneath. 

A handful of the tops of yarrow, infused in a quart of 
boiling water, in doses of a teacupful three or four times 
a day, is reputed to be a valuable medicine in dysentery, 



950 MATERIA MEDICA. 

bleeding piles, and in restraining immoderate flow of the 
menses. 



DIRECTIONS 

RESPECTING THE COLLECTION AND PRESERVATION OF VEGETABLE 

SUBSTANCES. 

Herbs and leaves are to be gathered in dry weather, 
after the dew is off, and are to be freed from decayed, 
withered, or foreign leaves. They are usually tied in bun- 
dles, and hung up in a shady, warm, and airy place, or 
spread upon the floor and frequently turned. If very juicy, 
they are laid upon a sieve, and dried by a gentle degree of 
artificial warmth. They should be dried in such quantities 
at a time that the process may be finished as quickly as 
possible ; for by these means their powers are best pre- 
served — the test of which is the perfect preservation of their 
natural color. 

Flowers ought also to be collected in clear, dry weather, 
after the dew is off, immediately after they have opened. 
They should also be dried nearly as leaves, but more quick- 
ly, and with more attention. As they must not be exposed 
to the sun, it is best done by a slight degree of artificial 
warmth. 

Barks and woods should be collected when the most act- 
ive part of the vegetables are concentrated in them, which 
happens in spring and in autumn. Spring is preferred for 
resinous barks, and autumn for those that are gummy. 
Barks should be taken from young trees, and freed from 
decayed parts and all impurities. 

Seeds and fruits should be gathered when ripe, but before 
they fall spontaneously. 

Roots which are annual should be collected before they 
shoot out their stalks or flowers. Those which are worm- 
eaten or decayed are to be rejected. The others are imme- 
diately to be cleaned with a brush and cold water, letting 
them lie in it as short a time as possible ; and the fibres and 



MATERIA MEDICA. 951 

little roots, when not essential, are to be cut away. Roots 
which consist principally of fibres, and have but a small 
top, may be immediately dried. If they are juicy, and not 
aromatic, this may be done by a moderate heat ; but if aro- 
matic, by simply exposing them, and frequently turning 
them in a current of cold, dry air. If very thick and 
strong, they are to be split or cut into slices, and strung 
upon threads ; if covered with a tough bark, they may be 
peeled fresh, and then dried. Such as lose their virtues by 
drying, or are directed to be preserved in a fresh state, are 
to be kept buried in dry sand. 

The proper drying of vegetable substances is of the great- 
est importance. It is often directed to be done in the shade, 
and slowly, that the volatile and active particles may not be 
dissipated by too great heat ; but this is an error, for they 
always lose infinitely more by slow than by quick drying. 
When, on account of the color, they cannot be exposed to 
the sun, and the warmth of the atmosphere is insufficient, 
they should be dried by an artificial warmth, less than one 
hundred degrees of Fahrenheit, and well exposed to a cur- 
rent of air. When perfectly dry and friable, they have 
little smell ; but after being kept some time, they attract 
moisture from the air, and regain their proper odor. 



952 FORMULAS OR RECIPES. 



FORMULAS OR RECIPES. 



In this chapter will be given all the important medicinal 
compounds which have been prescribed in this work. They 
are not very numerous — the author having, through all his 
professional life, been rather partial to simple remedies, and 
to giving one thing at a time ; for then he could anticipate 
with more certainty the precise result, and be better able 
to decide when to change the remedy, or to call to its aid 
something else which might enable it to succeed. But still, 
in the course of his experience he has been led to adopt 
certain combinations in which the separate properties of 
each article very happily come to the support of each of the 
others, so as to give a power over diseased action to the 
compound which is not possessed by any of its constituents. 
Now as the elements of disease are few, as has been before 
said in this work, these compound remedies may be made 
available in a great number of different cases of disease, 
and have therefore been repeatedly prescribed in preference 
to introducing others, which, if equally applicable, would at 
least serve to embarrass the common reader, and make it 
more troublesome and expensive to furnish himself with the 
necessary articles. But still, as the object to be accom- 
plished in the treatment of the various diseases has been as 
plainly set forth as was possible, it will not be difficult for 
any person to devise such combinations of medicines as will 
meet the indications. The knowledge of the virtues of 
remedies is generally easily obtained, but the knowledge of 
the nature of disease has always been the great difficulty, 



FORMULAS OR RECIPES. 953 

and just in proportion as the author has succeeded in 
enabling the reader to understand disease, ought the value 
of his work to be estimated. 



COMPOUND SYRUP OF VALERIAN, OR FEVER SYRUP. 

Syrup of rhubarb, four ounces ; tincture of valerian, two 
ounces ; oil of sassafras, twenty drops ; piperin, ten grains ; 
super-carbonate of soda, twenty grains. Mix. 

A point to be observed is that the oil of sassafras and 
piperin must be thoroughly mixed with the syrup before 
the tincture of valerian is added, otherwise the compound 
will be too pungent. For the manner of making the fever 
syrup upon a larger scale, see page 53. This compound will 
answer in more cases of sickness than any other I have ever 
known; very many families keep it and use it on every 
occasion when one of the members is out of health. But 
this is wrong, for the system after a while will become so 
accustomed to it as to destroy its usefulness in a great 
measure ; it should only, therefore, be given when there is 
some real necessity. The dose is from a teaspoonful to a 
tablespoonful, to be taken after each meal in derangements 
of the stomach, etc., and every two or three hours in fevers. 
It is best to give it in sweet milk, especially to children. 

CHLOROFORM LINIMENT. 

Sweet spirits of nitre, four ounces ; spirits of hartshorn, 
or aqua ammonia, one ounce ; chloroform, one ounce ; gum 
camphor, oil of sassafras, oil of juniper, each half an ounce. 
Mix. 

The chloroform liniment possesses great power in reliev- 
ing pain ; it may therefore be used in any case of suffering. 
It also will destroy the poison of tht, bite or sting of insects, 
and will subdue almost every kind of irritation upon the 
surface. See page 54. 

ANODYNE ALTERANT, OR COMPOUND SYRUP OF BUTTERNUT. 

Extract of hyoscyamus, one ounce ; extract of butternut, 



954 FORMULAS OR RECIPES. 

seven ounces ; oil of sassafras, half an ounce ; super-carbo- 
nate of soda, two ounces ; simple syrup, two quarts. Mix. 
See pages 449 and 871. 

This compound is also capable of very extensive applica- 
tion, it being suited to all cases in which there is a necessity 
for allaying nervous irritation, gently opening the bowels, 
and improving digestion ; it may be given in nearly all the 
nameless ills attendant on pregnancy, and for most of the 
ills of infancy. As it possesses many of the properties of 
the fever syrup, it may often be given in its stead. By 
adding thirty grains of piperin to the above formula, it 
comes still nearer to the fever syrup, and will offcener agree 
with the stomach. Dose from a teaspoonful to a table- 
spoonful three times a day, or oftener if required. 

EMULGENT PILLS. 

Calomel, compound extract of colocynth, and castile soap, 
each thirty grains ; make eighteen pills. Dose from three 
to five. See page 279. 

TONIC SYRUP FOR IMPROVING THE BLOOD. 

Take of elecampane root, four ounces ; water, one quart ; 
simmer for two hours, strain, and then simmer down to half 
a pint; add one pound of coarse brown sugar while the 
infusion is hot ; after it has cooled, add one ounce of burnt 
copperas, (sulphate of iron,) well pulverized and sifted. 
Mix thoroughly, and shake the bottle well before using 
each time. Dose, a teaspoonful after each meal. See 
pages 352, 353. 

This is a most valuable medicine in all cases of debility 
attended with an impoverished state of the blood, as in 
chlorosis, low stages of dropsies, etc. 

ALTERATIVE SYRUP FOR SCROFULA. 

Fluid extract of sarsaparilla, six ounces ; tincture of .vale- 
rian, two ounces ; syrup of rhubarb; two ounces ; piperin, 
thirty grains ; iodide of potassium, six drachms. Mix. 
Dose, a teaspoonful after each meal for a ciiild, to be taken 
in sweet milk. See page 352. 



FORMULAS OR RECIPES. 955 

Another : 

Wild cherry bark, elecampane root, and burdock root, 
each one ounce ; good spirits, one quart. Let it stand forty- 
eight hours; then strain and add one pound of coarse- 
grained cane sugar, and heat until it dissolves. Dose, a 
tabiespoonful for a child two or three years old. See 
page 352. 

ANODYNE CARMINATIVE. 

Good French brandy, half a pint ; pulverized cinnamon 
bark and nutmeg, each two drachms ; piperin, ten grains ; 
loaf sugar, a fourth of a pound. Dose, one or two tea- 
spoonfuls in four times its volume of milk three times a day, 
or oftener if required. See page 192. 

In case of irritable bowels, attended with green or foamy 
discharges, half an ounce of prepared chalk may be added 
with advantage to the above formula. 

LITHONTRIPTIC FOR DISSOLVING STONE AND GRAVEL. 

Fill a vessel with white sumach berries ; then pour on as 
much good apple vinegar as it will contain. Let it stand 
twenty-four hours, and then strain ; and to every quart add 
half an ounce of sulphuric acid. Dose, an ounce three times 
a day. See page 662. 

There is a poisonous variety of sumach which grows 
much larger, whose stems are thickly covered with fur, 
and bears a dark berry. 

REMEDY FOR LEUCORRHOEA, OR WHITES. 

Balsam copaiva, half an ounce ; sweet spirits of nitre, 
two ounces ; compound spirit of lavender, half an ounce ; 
simple syrup, three ounces. Mix. Dose, a teaspoonful 
from three to five times a day. See page 854. 

EMULGENT AND TONIC PILLS. 

Sulphate of quinine, thirty grains; blue-mass, twenty 
grains; piperin, ten grains; oil of sassafras, ten drops. 
Make fifteen pills. Dose, one every two hours to break 



956 FORMULAS OR RECIPES. 

chills, and one three times a day as an alterant and tonic. 
See page 277. 

ANTI-SYPHILITIC SYRUP. 

Compound syrup of valerian, or fever syrup, and com- 
pound syrup of sarsaparilla, each eight ounces; iodide of 
potassium, one ounce ; bichloride of mercury, or corrosive 
sublimate, thirty grains. Dose, a tablespoonful after each 
meal. See page 401. 

PREPARATIONS OF SLIPPERY-ELM. 

I have no intention of writing a history of the slippery- 
elm, but merely to refer to some new preparations of it 
which I have lately made, which I think are both con- 
venient and useful, explaining the mode of their prepara- 
tion, uses, etc. 

Of the medicinal properties of the slippery-elm I need 
say nothing — they are known to the profession, and to the 
people ; it is simply a cooling demulcent, and has been used 
from time immemorial as a soothing external application to 
inflammations, and as a cooling drink in internal irritations, 
etc. The value of the slippery-elm poultice to inflamed 
surfaces is well understood, but it is subject to two objec- 
tions : in many positions it cannot be easily applied so as to 
be retained in situ, [in place,] and is always disgusting to the 
nice and fastidious ; then it is subject to dry at the edges, and 
adhere with great tenacity, often causing as much harm in 
its removal as it did good in its application. To avoid these 
objections, I conceived the idea of combining it with some 
non-irritating substance which would not easily dry, and 
making it into cloth, so as to be of easy application and 
not subject to dry and adhere ; and also avoid the oppro- 
brium of nastiness. Chinese sugar-cane molasses seemed 
to possess the required properties, and I tried it and suc- 
ceeded. By first wetting the pulverized slippery-elm bark 
with water, so as to make a tough mass, and then adding 
the molasses until it became thin enough to spread, I suc- 
ceeded in obtaining the article desired. But I found this 
was not easily done, so as to present a smooth, even sur- 



FORMULAS OR RECIPES. 957 

face; after many efforts, however, I succeeded in the 
following manner : I spread smooth domestic on a flat non- 
absorbing surface, and spread the mass on it with a broad 
spatula as well as I could; I then laid another piece of 
cloth over it, and continued my efforts until I obtained the 
requisite finish ; then dried it in the sun. Afterward, by 
wetting the surface, the cloth will readily leave the compo- 
sition, and it presents the appearance of thick, wet parch- 
ment, and can be applied in a moment to any part of the 
body by simply wetting one side, and has the great advan- 
tage of adhering with sufficient tenacity to retain its 
position, and yet will never dry so as to become hard. It 
is better to allow the covering of cloth to remain until it is 
wanted for use, and then only remove that on the side 
intended to be applied to the inflamed surface. For appli- 
cation to sore eyes, and inflammations situated in various 
parts of the body in which it would be quite inconvenient 
to apply an ordinary slippery-elm poultice, cloth furnishes 
a very neat and suitable substitute. 

Slippery-elm has been long occasionally used as a bougie ; 
its soothing properties, united with its great powers of 
expansion by the absorption of water, naturally pointing it 
out as a suitable material for this purpose. But the great 
difficulty was to obtain it of a suitable form. This I effected 
in the following manner, viz. : I split the bark into fine 
slips, and then, when moistened, pressing them together, 
and wrapping them thoroughly with twine, and then dry- 
ing. It can now be trimmed by using a very short knife, 
and then polished with sand-paper. For very small bou- 
gies, a suitable piece of thick bark can, in a very few min- 
utes, be trimmed into the proper shape, and are preferable 
where we can obtain the bark of the necessary thickness. 

It is hardly necessary to dilate upon the advantage of 
this instrument; it operates more expeditiously, and with 
less suffering, than any other appliance of which I have 
any knowledge. Any amount of dilatation can be obtained 
by it. I have no doubt the urethra can be dilated suffi- 
ciently to admit of the removal of small stones with ease. 
In stricture of the urethra its use is signally beneficial ; it 



958 FORMULAS OR RECIPES. 

can be introduced when no other bougie or catheter can bo 
passed. 

A great advantage of the slippery-elm bougie over every 
other in efforts to enlarge the urinary passages, besides its 
soothing properties, is, that when made perforate, it can be 
allowed to remain until the full effect of its expansion is 
obtained, without having to be removed in order to allow 
the urine to pass. Would it not be the most suitable 
catheter to leave in the urethra after the operation of 
lithotomy ? 

While manufacturing the bougie, it occurred to me that 
this would be the very material of which to make pessaries, 
provided I could succeed in giving it the proper shape, 
which, after much trouble, I succeeded in doing; since 
then, I have succeeded in making them with less trouble, 
and also greatly increased their virtues by suitable medica- 
tion. 

My usual plan and formula is as follows : To one pound 
of flour of slippery-elm, I add four ounces of pulverized 
sassafras bark ; and of Dover's powder and balsam copaiva, 
each, two ounces ; add water slowly, and work the mass 
until it acquires the consistence of stiff dough ; then roll it 
into balls of from an inch to two inches in diameter, and 
put them in the sun or under a stove to dry; when they 
begin to feel hard, I moisten them, and, after some hours, 
manipulate them into shape, and then dry again; if they 
crack, or assume a bad shape, I again moisten them, and 
repeat the manipulations until I obtain the necessary shape 
and smoothness. 



ALOETIC PILLS. 

Take of socotorine aloes, in the finest powder, one 
drachm and a half; castile soap, one drachm; ginger, half 
a drachm. Beat them well together, and then add muci- 
lage or syrup sufficient to form a mass, which is to be 
made into forty-eight pills. Dose for adults, two at bed- 
time, or a sufficient number to keep the bowels in a regular 
state. 



FORMULAS OR RECIPES. 959 

ANTIMONIAL SOLUTION. 

Take of tartar emetic, six grains ; water, half a pint ; 
spirits of lavender, thirty drops ; sugar, one ounce. Mix. 
Dose for adults, a wineglassful every fifteen minutes, which 
should be encouraged by drinking freely of warm water, 
and afterwards turned downwards by taking a bowl of thin 
gruel made very salt. 

ANTISPASMODIC PILLS. 

Take assafoetida, three parts ; gum ammonia, two parts ; 
camphor, one part. Beat them well together, and, with as 
much syrup as is necessary, make into pills of the size of a 
common pea. From three to five may be taken at a dose, 
and repeated as often as may be found necessary; not, 
however, exceeding three or four doses in a day. This is 
a powerful antispasmodic, and very useful in all nervous 
and hysterical complaints. When it is wished to render 
the mass purgative, which is generally proper, add as much 
socotorine aloes as of camphor. 

DIURETIC PILLS. 

Take dried squills in fine powder, and calomel, each half 
a drachm; mucilage of gum-arabic, sufficient to form a 
mass ; and then make twenty pills, two of which are to be 
taken at bedtime. When the squill alone is given, it may 
be taken in doses of two or three grains, three or four times 
a day, in the form of pills, by adults. 

COUGH MIXTURE. 

Take of elixir paregoric, one ounce and a half; antimo- 
nial wine and syrup of squills, each one ounce ; lac ammo- 
niac, four ounces ; syrup bal. tolu, one ounce. Dose, half 
a tablespoonful every two or three hours for adults. 

Or, take of tincture of opium, one drachm; wine of 
ipecacuanha, half a drachm; oxymel of squills, half an 
ounce. Mix. Dose for adults, a teaspoonful every two 
hours while the cough is severe. 
61 



FORMULAS 

NOT FOUND IN ANY FORMER EDITION OF THIS WORK. 



FOR SKIN DISEASES. 



For acne, or hard pimple, appearing chiefly on the face 
of healthy and vigorous young persons: Bi carbonate of 
soda, half an ounce ; bi chloride of mercury, (corrosive sub- 
limate,) four grains; water, one pint. Mix, and apply every 
morning and evening. 

FOR SCALD-HEAD. - 

Beefs-foot oil, four ounces; oil of sassafras, one drachm, 
or common tea-spoonful. Mix. Apply once a day. 

FOR ECTHYMA BURNING TETTER. 

Laudanum, half an ounce; spirits of camphor and glyc- 
erine, each one ounce; water, six ounces. Mix. Sponge 
the surface twice a day. 

FOR LICHEN, 

And other eruptions attended with much burning and 
itching: Laudanum, one ounce; oil of sassafras, half an 
ounce; glycerine, four ounces. Apply with a mop once or 
twice a day. 

FOR SCABIAS, OR ITCH. 

Flour of sulphur, two ounces; honey, four ounces; iodide 
of potash, half an ounce; water, four ounces. Mix, dissolve, 
and shake well, and give from a tea-spoonful to a table-spoon- 
ful, according to age. Repeat night and morning until aU 

960 



FORMULAS. 961 

appearance of the disease has been absent for a week or 
ten days. 

FOR HERPES, OR MOIST TETTER. 

Corrosive sublimate, thirty grains; oil of sassafras, half 
an ounce; alcohol, four ounces. Mix. Apply once a day 
until some inflammation is set up, then discontinue and use 
only glycerine. If the disease threatens to return, use 
again the above ; and this may have to be done until the 
third or fourth time before the tetter will cease to reappear. 
This prescription will cure all the stubborn skin diseases, 
such as tinea capitis, or scald-head, crusta lactea, or milk 
scab, etc. If, however, it should fail to get up some in- 
flammation of its own in a few days, there must be more 
corrosive sublimate added. Double the quantity advised 
has been used with impunity. 

FOR HEMORRHAGES. 

Bleeding at the nose. A plug of fat bacon, tapered to 
fit the nostril, and pushed in tight and far enough to reach 
the throat. 

BLEEDING FROM THE LUNGS. 

A teacupful of salt and water, as strong as it can be 
made. 

BLEEDING FROM THE STOMACH. 

A heaping tea-spoonful of common wheat flour stirred 
into a glass of cold water, and drank at once. This will 
arrest any internal hemorrhage, whether from the stomach, 
bowels, uterus, or kidneys, etc. 

FOR ARRESTING PROFUSE DISCHARGE FROM ULCERS, 

And bringing them to a healthy condition. Pulverized 
nutmeg and calomel, equal parts. Rub them together, and 
dust the sore once or twice a day. 

FOR IRRITABLE URETHRA OR BLADDER. 

Symptoms like gravel in pregnancy. Bromide of potassa, 
fifteen grains three times a day. 



962 FORMULAS. 

Or, creosote, twelve drops; cinnamon water, two ounces. 
Mix. Give a teaspoonful every three hours. 

Or, bi carb. potassa, one drachm; water, half a pint. 
Mix. Give a table-spoonful every three hours. 

FOR GONORRHEA. 

Oil of gregeron, ten drops taken on a lump of sugar 
every three hours until cured. 

INJECTION FOR GONORRHEA. 

Acetate of lead and sulphate of zinc, each eight grains; 
water, four ounces. Inject immediately after passing urine 
each time. 

FOR LEUCORRHEA OR WHITES. 

Tincture of iodine, one ounce; water, one pint. Mix. 
Inject freely with soap-suds, then with plain water, and 
then inject half a teacupful of the above on going to bed. 
Repeat every night. 

FOR DIPHTHERIA. 

Per manganate of potassa, one-half grain; white sugar, 
the size of a pea. Rub together and place it on the child's 
tongue. 

Elixir vitriol; three times as much water. Apply with 
small mop to the false membrane. 

FOR BOWEL COMPLAINTS, COLIC, ETC. 

Oil of anise and oil of cinnamon, each twenty drops; 
spirits of camphor, spirits of niter, sulphuric ether, lauda- 
num, each sixty drops. Mix. Dose for an adult, from 
thirty to sixty drops. 

FOR DROPSY. 

The following was a great favorite with Dr. Parrish, and 
has been used with much advantage by myself. Take of 
juniper berries, mustard seeds, ginger root, each, bruised, 
one ounce; horse-radish, parsley-root, each, bruised, two 
ounces; hard cider, two quarts. A wine-glassful to be 
taken four times a day, and gradually increased. 



DISPENSATORY. 96 



,1 O 



TABLES OF MEDICINE. 



The following tables of medicine will be found sufficient 
to answer every purpose of practice, and the expense will 
be found nothing compared to the great advantages which 
must result from being constantly supplied with them. To 
render the work still more complete, I have, in these tables, 
annexed to the medicines their doses, according to the age 
of the patient ; observing, however, that whatever general 
rule may be given, it can only be applied with reference to 
the habit and state of the patient. The judgment of the 
person who administers the medicine must, therefore, be 
exercised in this respect. It will be found that the consti- 
tution is often attended with certain peculiarities, both in 
relation to medicine in general, and also to certain sub- 
stances particularly, which knowledge is only to be obtained 
by experience. 



EXPLANATION OF WEIGHTS AND MEASURES. 

gr 20 grains make . ... 1 scruple. 

9 3 scruples .... 1 drachm. 

Z 8 drachms . . . . .1 ounce. 

3 12 ounces ..... 1 pound. 
A teaspoonful is equal to 60 drops, or 1 drachm. 
A tablespoonful is the measure of \ ounce. 
A large wineglassful is equal to 2 ounces. 



96* 



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APPENDIX. 



There are a few subjects, which have been omitted from 
the body of this work, that are deemed of sufficient im- 
portance to be placed in an appendix. Of these are, first, 

HERNIA— RUPTURE. 

Hernia signifies a protrusion of any of the constituents 
of the body through the sack or investing membrane which 
naturally confines or contains it. Thus, when the skull is 
broken and a part of it displaced, the brain often protrudes 
through the opening, and is called hernia cerebri, but the 
term hernia will here be confined to designate the protru- 
sion of the contents of the abdomen, or belly. This gen- 
erally takes place in the front part of the body, where the 
walls are thinnest or weakest, and most often through the 
natural openings through which the great blood-vessels 
pass, as in the groin. The complaint has received different 
names indicating the locality of the misfortune, as umbilical 
hernia when the rupture is at the navel, inguinal hernia when 
it is in the groin, and femoral hernia when the parts escape 
through the opening which gives passage f -o the great fem- 
oral artery, veins, etc. Inguinal hernia is incomparably the 
most common, and will be kept in view in the following re- 
marks. In this case some of the contents of the abdomen, 
generally a little of the omentum, which is that fold 
of the peritoneum reflected from the stomach and great 
arch of the colon, and falls loosely down over the other 
viscera, and hence is aptly called the apron. But after the 

967 



968 APPENDIX. 

disease has continued some time, and the opening becomes 
larger, other contents of the abdomen protrude, until, in 
some old cases, the greater part of the bowels hang outside 
of the belly, forming a troublesome and unsightly tumor, 
occupying the scrotum, greatly enlarged, sometimes de- 
scending half-way to the knees. In the early stage of this 
disease it is often mistaken for buboes, or scrofulous enlarge- 
ments of the inguinal glands, but may easily be distin- 
guished from these by placing the patient on his back and 
making pressure on the tumor; if it be a hernia the tumor 
will quickly disappear, and the finger can detect the open- 
ing through which it has escaped into the belly. It is very 
fortunate to the patient when the nature of the disease is 
discovered thus early, as it can now be remedied with very 
little difficulty. The brains of the medical profession, and 
those of many outsiders, have been exercised for hundreds 
of years in devising mechanical means for remedying this 
defect in the walls of the abdomen, and cart-loads of trusses 
may be collected among the rubbish in any of our large 
drug establishments, indicating the general failure of suc- 
cess. And yet a very simple contrivance will insure 
success. What is necessary to be accomplished in these 
cases is to keep the part from protruding, not generally, 
but always and certainly. For, should you succeed ninety- 
nine times and fail in the hundredth, the disease in that 
case is not only not benefited, but is made Avorse. Now, 
no truss which depends on a spring can ever succeed. If 
the spring be made strong enough to resist the ordinary 
straining incident to common labor it will cause so much 
distress that the patient can not, nor ought he to bear it. 

A very simple contrivance, which any person of common 
sense can make for himself, will answer the purpose com- 
pletely. Procure a piece of firm sole-leather two and one- 
half inches one way and five inches the other; whittle 
out a piece of hard wood the size and shape of half a 
small hen's egg; place this about the middle of the piece 
of leather, and then drive saddler's tacks through the 
leather into it sufficient to fix it firmly. Now tack on 
some straps with buckles attached to each end of the 



HERNIA RUPTURE. 969 

leather; place this leather obliquely, so that one part 
will extend downward toward the scrotum, and the other 
point upward toward the back part of the shoulder on that 
side; adjust the end of the egg-shaped piece of wood to 
the hole — which. you can feel — through which the hernia 
has been returned. Now, by suitable straps, one coming 
round the body, and another passing round the thigh from 
the lower buckle, you can easily fix this little conical ball 
so that it will press firmly into the canal through which 
the hernia has passed. A little effort on the part of any 
person of ordinary sense will enable them, after a few tri- 
als, to succeed in adjusting this instrument so that it will 
effectually keep the protruding part up, and in a short time 
adhesions will take place so as to make the misfortune 
much less likely to occur than in cases in which it had 
never happened. 

When it is considered that, as some have estimated, one- 
fifth of our male population are ruptured, and that it is 
rarely cured by ordinary means, the importance of the 
above suggestions may in some measure be estimated. 
Any stage of this disease may be managed upon this plan, 
but of course the size of the plug must correspond to the 
extent of the opening. The author once successfully 
treated a case in which at least one-half of the contents 
of the abdomen hung down between the legs, and almost 
prevented locomotion. 

But if you think you have not sufficient mechanical con- 
trivance to make such a truss for yourself, inquire for Ban- 
ning' s Supporter Truss. . It acts upon pretty much the same 
principle as the above. Every person who has the misfor- 
tune of being ruptured should be careful not to let the 
hernia remain out any considerable time, as adhesions may, 
and are very likely to take place between the part pro- 
truded and the hernial sack, whir^h would prevent the return 
of the hernia. And then, while it is out, there is constant 
danger that it may become strangulated. This may take 
place when the part protruded may become swollen from 
having been bruised, or when there is a fold of the bowels 
involved by the forcible injection of wind or faeces into it. 



970 APPENDIX. 

In this case the ring, through which the hernia passes, acts 
as a ligature to prevent the return of blood through the 
veins, while the arteries, by having a greater propelling 
power, still force the blood into it. In this way the press- 
ure may soon become so great as to cause even mortifica- 
tion of the part. Perhaps there is no case dwelt upon in 
this work in which it is more important that the people 
should understand what to do in the absence of a physician. 
I will therefore be as plain as possible on this subject. As 
soon as you find that the hernia is strangulated, which may 
be known at once by a sudden enlargement and the part 
becoming painful, place yourself on your back, with the 
hips considerably higher than the body, and, having covered 
the part with a warm, wet cloth, proceed to use the taxes; 
that is, place one hand flat over the tumor, and with the 
fingers of the other manipulate by stuffing the contents 
into the belly through the ring. It was formerly the cus- 
tom to bleed and give nauseants in order to produce relax- 
ation, but now we use ancesthesis; that is, make the patient 
inhale chloroform or ether, or, what is better, both of these 
combined. If, therefore, you can not reduce the hernia by 
the taxes and position, send immediately for your doctor; 
and if no intelligent physician can be had, some neighbor, 
who has common-sense and firmness, and, after inhaling the 
ansesthesis until you begin to hear ringing in your ears, let 
him go vigorously to work to push the contents of the 
hernia through the ring. If the part can not be returned, 
and begins to turn black, and become insensible, you may 
know that mortification is taking place, and a competent 
surgeon must be obtained, or a fatal result will probably 
speedily follow. And yet there have been cases in which 
a considerable fold of the bowel has mortified and sloughed 
off, and yet the patient did not die. 



ON MARRIAGE— CHILD-BEARING. 

I have thought, and still believe, that dissertations on 
morals, family government, etc., were out of place in a 



ON MARRIAGE CHILD-BEARING. 971 

medical work, and had better be left to those whose busi- 
ness it is to teach these things ; but there is one subject 
which I think is so closely allied to medicine that it may 
appropriately find a place in this appendix : I mean the 
subject of Marriage and Child-bearing. 

There is no subject less under the direction of science or 
sound judgment than choosing a companion. Some are in- 
fluenced by a symmetrical form, or a beautiful face ; others 
by conversational powers, either sprightly or lighted by the 
scintillations of genius ; others by wealth ; some by posi- 
tion, and a multitude by mere convenience. Now, any, or all 
of these, will not furnish a good foundation for a union in 
the marriage state unless there also be a physiological adap- 
tation. One very important matter is temperament. If 
two come together of the same temperament the union can 
never be a happy one. If of the bilious melancholic, they 
will mope together through life, each acting toward the 
other as a somber cloud, shutting out every ray of genial 
light, and their offspring will be misanthropes, lunatics, or 
fitted for deeds of darkness. Should both be of the san- 
guino-bilious, neither will give an inch, and bitter collisions 
will certainly be frequent, and their children will be the 
terror of their neighborhood, and a scourge to society. 
Then suppose both are of the sanguine, their lives will be a 
constant alternation of sunshine and showers, of calms and 
storms, of quarrels and embraces; and, should both be of 
the petuitary or phlegmatic, they will listlessly float through 
life, without object or aim, and their offspring will die before 
they form any character. But, fortunately, instinct power- 
fully tends to prevent such unions, and if consulted would 
do it always. Upon taking a survey of married life, in a 
pretty large scale, if you never thought of it before, you 
will be astonished to find how generally opposites have been 
united. Those who are tall naturally take to the short, and 
the converse ; a great talker likes a good listener ; and the 
quiet love the , hilarious ; so will the weak and beautiful 
cling to the strong and the rough. The man of deep 
thought and erudition will choose a companion who can 
cheer and enliven him, and do n't want her to be scientific. 



972 APPENDIX. 

The same instinct very generally causes a mixing of the 
temperaments. If it were not so the race would soon be- 
come depraved, and afterward extinct. We can not extend 
this chapter so as to show the bearing which unions of the 
same temperament will have upon the minds, morals, and 
health of the descendants through all their combinations, 
but will leave the reader to study it out by looking around 
upon society and noticing the consequences. 

There is still another matter, even of more consequence 
than this, which should be looked to in choosing a mate for 
life; that is, the actual state of present health. Now, 
what can be more foolish than for two tuberculous or con- 
sumptive individuals to come together in the marriage rela- 
tion, the certain consequence being an early death of both; 
and if they should live long enough to be surrounded with 
fair, beautiful, precocious, bright-eyed children, to see them 
drop off, one after another, to fill a little grave. And, if 
only one be tainted with these terrible diseases, why should 
that one blast his fair prospects of earthly happiness with 
only the certainty of hastening the fatal issue with the 
other ; and, most probably, also entailing the same disease to 
posterity? In this same category may justly be classed 
those who inherit cancer, lunacy, leprosy, etc. I look upon 
the marriage relation as the natural condition of our race, 
and no individual can enjoy the full measure of happiness 
traveling life's journey alone that he might if united with a 
congenial companion. But those who are afflicted with 
these incurable maladies will not add to their enjoyment by 
marrying, and will certainly shorten their lease of life. 
Then why should a sound individual marry such an one, 
when the certainty is that the grief of an early separation 
is inevitable, and the chances are two to one that both will 
go near together? It is now settled beyond all dispute that 
consumption, at least, is often communicated to a healthy 
individual by living in close connection with one suffering 
from that disease. Within my own observation there have 
occurred quite a number of very clear examples of this. 
Only a few years ago I knew a family, consisting of a 
father, who was decidedly consumptive, three children, 



ON MARRIAGE CHILD-BEARING. 973 

who were beautiful and precocious, a mother, who was 
the picture of health, and a sister of hers, who was as 
sound as lignum vita. But the father at last sunk under 
the disease; lingered long enough, however, to infect 
his wife, who took to her bed on coming from his grave, and 
in two months was laid beside him. Her sister naturally 
became her nurse, breathed the infected atmosphere, and 
she, too, was laid in the same row before the close of the 
year, and three little graves are now beside them. I am 
aware that common humanity, as well as natural affection, 
will render it imperative that we do not forsake our declin- 
ing friends, but common prudence will dictate that the 
nurse should not sleep in close proximity to the invalid, and 
that they should enjoy as much fresh air as possible. 

Disinfectants should always be freely used in the sick- 
room, and the discharges from the lungs removed very 
often. As good a disinfectant as any, and a cheap one, is 
Copperas. 

We will make a few observations about Child-bearing. 
As the marriage relation is the natural condition of both 
man and woman, so is child-bearing the natural condition of 
woman, and, failing in this, she will inevitably suffer a pen- 
alty ; and this will be inflicted whether she be to blame for 
the omission or not. I confidently assert that a woman at 
forty, who has had ten children, and even had to toil to 
support them, will be stronger, and sounder, and look 
younger than her sister, who has never married, and lived 
at ease, will at thirty-five. And if married, and has used 
means the most innocent for avoiding conception, the differ- 
ence will be still greater. Within a few years past a su- 
icidal mania has taken hold of a large class of American 
women upon the subject of bearing children. I suppose ev- 
ery physician of much practice has noticed the great increase, 
lately, of applications for means to prevent conception, 
and to procure abortion ; and I am ashamed for my profes- 
sion, and of my common humanity, to acknowledge that 
every-where, and especially in every city, there can be 
doctors found, who, for a consideration, will destroy one life 
and endanger another. As God commanded man to multi- 



974 APPENDIX. 

ply and replenish the earth, this, as well as every other of 
his commands, can not be transgressed with impunity. If 
any physician tells of innocent means for preventing con- 
ception, or of procuring an abortion, you may set him down 
as either a fool or a knave. Even, as is sometimes the 
case, when an abortion has to be brought about to save the life 
of the mother, it is looked upon by every sensible, right- 
minded physician as one of the gravest acts coming within 
the range of his professional duties. I am aware of the 
thousand and one excuses that females make for desiring to 
have the fruit of their womb blasted. Some are too poor 
to maintain children ; others are too delicate to bear the ills 
and sufferings attendant on having children; still others 
can not endure the privation of being cut off from society ; 
and again others, with more show of reason, desire 
exemption because of a dissipated or worthless husband. 
Such are indeed objects of commiseration : but even these 
had " better bear the ills they have than fly to those they 
know not of." And how often have we seen children, in 
such cases, prove a blessing in disguise; being a solace 
while little, and a support in age. It is one of the darkest 
questions in Psychology why the maternal instinct should be 
so strong toward even a new-born infant and yet so weak, 
and often totally wanting, toward the child unborn. It is 
not so in nature ; even the sparrow will watch its nest, and 
bravely attack the crow or jay-bird, to prevent her un- 
hatched eggs from being destroyed. As I believe it to be 
the duty and the interest of married women to bear chil- 
dren, and, as there are many cases in which the woman, 
without any fault on her part, fails to receive pledges of 
love, it seems to be proper that I should give them such 
advice as the case admits of for removing this misfortune. 
If any of the uterine derangements, which have been 
treated on in this work, be the hindering cause, resort 
should be had to the means laid down in each case for its 
removal. But sometimes none of these are present, and 
yet conception does not take place. This is often the con- 
sequence of a lack of tone in the womb, and especially in 
the ovaries. This may be inferred to be the case when 



ON MARRIAGE CHILD-BEARING. 975 

there is decided lack of desire for sexual intercourse. Iu 
this case try the following compound ; it has often suc- 
ceeded: 

Tincture of Valerian, four ounces; tincture of Cin- 
chona, two ounces ; tincture of Capsicum, one-half ounce ; 
syrup of Wild Cherry, one and one-half ounces. Mix. 
Take a dessert-spoonful after each meal, in a little water. 
Besides this, add as much common salt to hot water as it 
will dissolve, then immerse a piece of flannel into the solu- 
tion, let it dry, and rub well with this every night and 
morning, especially the small of the hack, the lower part 
of the abdomen, and the thighs. 
62 



GLOSSARY, 



OR DICTIONARY OF THE TECHNICAL AND PRINCIPAL 
WORDS USED IN THIS WORK. 



Remarks. — For the convenience of the reader, the author has thought 
proper to not only define all the technical words and phrases used in this 
book, but also most of the other principal words — thus avoiding the 
necessity of referring to a dictionary ; and, further, to make the task of 
becoming familiar with their use easy and pleasant, he has given the 
accent and pronunciation, which will not only be of great assistance to 
the common reader, but will commend the work to the medical student 
who is not a classical scholar, as this advantage can be found in few of 
the best medical dictionaries. 

Another reason for defining words not strictly technical is, that many 
have a different meaning in medicine from that attached to them in 
common usage. 



Ab'do-men, The belly. 

Ab-dom'i-nal, Pertaining to the belly. 

Ab-er-ra'tion, Wandering. 

Ab-lu'tion, The washing of the body, as by baths. 

Ab-nor'mal, Deviation from health. 

A-borl/, To miscarry in birth ; to arrest the progress of a disease. 

A-bor'tion, The act of miscarrying ; a failing to arrive at maturity. 

A-bor'tive, Failing in its effects; coming to naught; producing nothing 

Ab-rade', To rub or wear off; to waste by friction. 

Ab-rad'ed, Rubbed or worn off; action of sharp, corrosive medicines. 

Ab-ra'sion, The act of wearing away or rubbing off. 

Ab'scess, A tumor containing matter. 

9Y7 



978 GLOSSARY. 

Ab-sorb', To drink in ; to imbibe as a sponge. 

Ab-sorb'ent, A vessel which imbibes ; a powder or substance which im- 
bibes the humors of the body. 

Ab-sorp'tion, The act of drinking in or imbibing. 

Ab-ste'mi-ous, Refraining from the free use of food or strong drinks. 

Ab-ste'ini-ous-ness, The quality of being temperate or sparing in food and 
drink. 

Ab'sti-nence, The refraining from an indulgence of the appetite; a 
fasting. 

Ab-strac'tion, The act or state of being separated; absence of mind. 

Ac-cel'er-ate, To hasten ; to quicken motion. 

Ac-cess'ion, A coming to; an acceding to and joining; that which is 
added; augmentation. 

Ac'ces-so-ry, Contributing ; aiding in producing an effect. 

Ac-cou-cheur / , A man who assists women in childbirth. 

A-ces'cent, Turning sour ; becoming acid by spontaneous decomposition. 

A-ce'tous, sour ; having the nature of or like vinegar. 

Ac-e-tab'u-lum, Socket of the thigh-bone. 

Ac'e-tate, A neutral salt, formed by the union of acetic acid with any 
salifiable base. 

A-ce'tic, A term used to denote a particular acid. 

Ac'id, sour, sharp, or biting to the taste; having the taste of vinegar. 

A-cid'i-fied, Made acid ; converted into acid. 

A-cid'i-fy, To convert into acid. 

A-cid'ity, The quality of being sour. 

A-cid'u-late, To make acid in a moderate degree. 

Ac'me, The top or highest point. 

Ac'ne, A small, hard pimple on the face. 

Ac'o-nite, The herb wolf's-bane. 

Ac'rid, sharp ; pungent ; bitter ; biting to the taste. 

Ac'ri-mo-ny, sharpness ; a quality of bodies which corrodes or destroys. 

A-cu'mi-nate, Ending in a sharp point; pointed. 

A-cute', sharp at the end. An acute disease is one which is attended 
with violent symptoms, and comes speedily to a crisis. 

Ac'noea, A disease consisting of pimples. 

Ad-he'sion, The act or state of sticking or being attached to. 

Ad-he'sive, Sticky ; tenacious or glutinous. 

Ad'i-pose, Fat. 

Ad-ja'cent, Bordering upon; that which is next to, or contiguous. 

Adjunct, Something added to another, but not essentially a part of it. 



GLOSSARY. 979 

Ad-ju'vant, An assistant; that which helps or aids. 

Ad-ju'vant, A medicine that assists and promotes the operation of others. 

A-dul'ter-ate, To make impure by the admixture of baser materials. 

A-dy-nam'ic, Weak ; impotent ; a low grade of fever. 

A-e-ra'tion, Exposure to the atmosphere. 

Afflux, The act of flowing to, or that which flows. 

Af-fu'sion, The act of pouring upon. 

Al'a, A wing. 

Al-bu'men, A peculiar substance found in the white of an egg, in blood, 

muscles, bones, etc. 
Al'e-poi-ca, A substance similar to arrow-root. 
Al'i-ment, That which nourishes ; food. 
Al-i-ment'a-ry, Pertaining to aliment or food. 
Al-i-ment'ary Ca-nal', The stomach and intestines. 
Al-i-ment-a'tion, The act or power of affording nutriment. 
Al'ka-li, Any substance capable of combining with and destroying the 

acidity of acids. 
Al'ka-line, Having the properties of alkali. 
Al-lay', To make quiet ; to abate or subdue. 
Al-lu'vi-al, Carried by water and lodged. 
Al-o-et'ic, A medicine consisting chiefly of aloes. 
Al'ter-ant, A medicine which gradually corrects the state of the body. 
Al'ter-a-tive, Causing alteration ; having power to change. 
Al-tern'ate, To happen or act by turns. 
Al-tern'a-tive, Offering a choice of two things. 
AFve-o-la, Little pits, cells, or sockets ; sockets of the teeth. 
Al've-o-lar, Containing sockets. 

Al'vine, Belonging or relating to the belly or intestines. 
Am-au-ro'sis, A loss of sight without any visible defect in the eye. 
A-me'lio-rate, To make better ; to alleviate. 
A-men-or-rhoe'a, A partial or total obstruction of the menses. 
A-men-or-rhe'sis, An obstructed state of the menses. 
Am-mo'ni-a, A volatile alkali. 
Am-mo-ni'a-cal, Pertaining to ammonia. 
Am-mo-ni'a-ted, Mixed with ammonia. 
A-morph'ous, Having no regular form. 
Am'pu-tate, To cut off. 

A-nal'o-gy, An agreement or likeness between things. 
A-nal'o-gous, Resembling; similar. 
An'a-lyze, To separate into constituent parts. 



980 GLOSSARY. 

An-a-sar ca, A dropsy of the cellular tissue. 

An-ses-the'sia, Loss of sensibility. 

An'eu-ii?m, A preternatural dilatation or rupture of the coats of an 

artery. 
An-gi'na, A quinsy; an inflammation of the throat. 
An-gi'na Pec'to-ris, A spasmodic affection of the chest, or neuralgia of 

the heart. 
An-em'ic, Impoverished state of the blood. 
An-c'mia, Privation of blood. 

An-i-mal'cule, An animal or insect not visible to the naked eye. 
A.n'i-mal-ize, To give animal life; to endow with the properties of 

animals. 
A-nom'a-lous, Irregular; deviating from a general rule. 
A-nom/a-lies, Deviations from rule 

An'o-dyne, Any medicine which allays pain and causes sleep. 
A-nae'mia, A disease consisting of a loss of blood, or an impoverished 

state of the blood. 
An'o-rex-ia, Want of appetite. 
Ant-ac'id ? A remedy for sourness or acidity. 
An-te'ri-or ? Before in time or place; prior. 
An-te-ri-or'i-ty, State of being before. 

An-thel-min'tic, Medicine that kills worms; good against worms, 
An'ti-dote, A medicine to counteract the effects of poison.' 
An-ti-mo'ni-al, A preparation of antimony. 
An-ti-phlo-gis'tic 7 Counteracting inflammation. 
An-ti-sep'tic, Counteracting putrefaction. 
An-ti-spas-mod'ic, A remedy for spasms or convulsions. 
An-ti-scor-bu'tic 7 Good against the scurvy. 
An-tro-ver'sion, A falling forwards. 
A'nus, Orifice of the alimentary canal. 
A'num, Per A'num, By the fundament. 
A-ort'a, The great artery or trunk of the arterial system. 
A-ort'ic, Belonging to the aorta. 
Ap'a-thy, Want of feeling ; insensibility to pain. 
A-pe'ri-ent, A gently purgative medicine. 
A-pho'nia, Loss of the voice. 
Aph'tha, The thrush. 

Aphthous, Relating to the throat; thrush-like. 
Aph-nce'a, Difficulty of breathing. 
A'pi~ces ; Sharpened terminations. 



GLOSSARY. 981 

Ap'o-plexy, A sudden deprivation of all sense and voluntary motion. 

Ap-po-si'tion, Placed in contact; a setting together. 

A'que-ous, Watery. 

A'qua Ammonia, Water of ammonia. 

A-rach'noid, A semi-transparent membrane spread over the brain. 

Ar-e-o'la, The colored circle around the nipple, or a pustule. 

Ar-o-mat'ic, Fragrant; spicy; pungent. 

Ar'o-ma, The quality of plants which constitutes their fragrance. 

Ar-tic'u-la-ted, Jointed. 

Ar-tic'u-lar, Belonging to the joints. 

Ar'te-ry, A cylindrical tube, conveying blood from the heart. 

Ar-te'ri-al, Pertaining to the arteries. 

Ar-te-ri-al-i-za'tion, The formation of blood. 

As-car'i-des, A species of small worms infesting the lower bowel. 

As-car'is Lum-bri-coi'des, Large, round, intestinal worms. 

As-ci'tes, A kind of dropsy ; elastic swelling of the belly. 

As-per'i-ty, Roughness of surface. 

As-per'sion, A sprinkling. 

As-phyx'ia, Apparent death ; suspended animation. 

As-phyx'ia-ted, In an insensible state ; apparently dead. 

As-sim'i-late, To bring to a likeness. 

As-sim'i-la-ted, Changed into a like substance. 

Asth'ma, Difficulty of breathing, with cough and wheezing. 

Asth-mat'ic, Pertaining to asthma. 

As-then'ic, Weak ; characterized by extreme debility. 

As-tring'ent, Binding; contracting. 

As-tute', Shrewd ; learned. 

At'o-my, Same as Anatomy. 

At'ro-phy, A wasting of the flesh. 

At'ro-phied, Wasted. 

At-ten'u-ant, Making thin ; medicines for reducing the body. 

Au'gu-ry, An omen; prognostication. 

Aug'ment-ed, Increased. 

Au'ra-epi-lep-tic, A peculiar sensation preceding a fit of epilepsy, 

Au'ri-um, Ringing in the ears. 

Aus-cul-ta'tion, Method of distinguishing diseases by listening to sounds 

through a tube applied to the surface. 
Ax'il-la, The arm-pit. 

Bane'ful, Poisonous; hurtful. 



982 GLOSSARY. 

Bar'na-cle, A shell found on the bottom of ships ; rocks and timber 
below the surface of the sea. 

Bi-car'bo-nate of Soda, The common soda of the shops; the super- 
carbonate of soda. 

Bile, A yellow, bitter liquor, separated from the blood in the liver. 

Bil'ia-ry, Belonging to bile ; conveying bile. 

Bis'tou-ry, A surgical instrument for making incisions. 

Bland, Mild ; soft ; gentle. 

Bou-gie', A taper body, introduced into a passage to keep it open. 

Bron'chia, The smaller ramifications of the wind-pipe. 

Bron-chi'tis, Inflammation of the bronchia. 

Bron-chot'o-my, An incision into the wind-pipe. 

Bro'mi-um, The base of bromic acid. 

Bu'bo, A tumor or abscess in certain glandular parts, as the groin or 
arm-pit. 

Bul-lse, Little blisters. 

Bur-sse — Bursae Mucosum — Little bags or glands which furnish lubri- 
cating matter for the joints, tendons, etc. 

Ca-chex'ia, A deranged state of the constitution without fever or nervous 

disease. 
Ca-chec'tic, Having an ill habit of body. 

Cae'cum, The commencement of the large intestines ; the blind gut. 
Ca-dav'er-ic, Pale; death-like. 
Cal'cu-lous, Stony; gritty. 
Cal'cu-li, Stones; gravel. 
Cal'cu-lus, The stone in the bladder. 
Cal-ca're-ous, Partaking of the nature of lime. 
Cal'lous, Hard; insensible. 
Cam'pho-ra-ted Tincture of Opium, Paregoric. 
Can-thar'i-des, Spanish flies, used to raise blisters. 
Can'u-la, A small tube. 

Ca-pri'cious, Freakish; whimsical; unsteady. 
Cap'si-cum, Guinea pepper. 
Cap'il-la-ry, A fine vessel or canal. 

Cap'il-la-ries, The very minute vessels between the arteries and veins. 
Cap'il-la-ry Tro'char, A very fine instrument. ' 
Cap'sules, Little globes of gum-arabic containing medicine. 
Car'bon, An elementary substance forming the basis of animal and 

vegetable charcoal. 



GLOSSARY. 983 

Car'bon-a-ted, Combined with carbonic acid. 

Car'di-ac, Pertaining to the heart. 

Car'di-ac Re'gion, Region of the heart. 

Card'a-mom, An aromatic seed. 

Car-di'tis, Inflammation of the fleshy substance of the heart. 

Car-di-al'gi-a, Heartburn. 

Car-ci-no'ma, A cancer. 

Car-di-ac Or'i-fice, Upper orifice of the stomach. 

Car'i-ca-ture, A ridiculous or grotesque resemblance. 

Ca'ri-es, The decay of a bone. 

Ca'ri-ous, Decayed, rotten, as a tooth or bone. 

Car-min'a-tive, Medicine which tends to expel wind, and relieve colic and 

flatulence. 
Ca-rot'id Ar'te-ries, Great arteries of the neck. 
Car'ti-lage, Gristle ; a solid elastic substance softer than bone. 
Cat'a-plasm, A poultice or soft plaster. 
Ca-tarrh', A discharge from the head or throat. 
Ca-tarrh'al, Produced by cold or catarrh. 
Cat'a-lep-sy, A nervous affection, in which the spasms hold the patient 

in one position and senseless. 
Ca-thar'tic, A purgative medicine. 
Cat-a-me'ni-a, Monthly Sowings of females. 
Cat'e-chu, An astringent vegetable extract. 
Cath'e-ter, A tubular instrument to draw off urine. 
Cav'ern-ous Res-pi-ra'tion, A hollow sound produced by cavities in the 

lungs. 
Caus-a'tion, The act of causing or producing ; the agency by which an 

effect is produced. 
Caus'tic, Burning; corroding like fire. 
, Cau'ter-ize, To burn or sear with a hot iron, or caustic medicines. 
Cau'ter-y, That which burns or sears. 
Cel'lu-lar, Consisting of little cells. 
Cel'lu-lar Tis'sue, A loose substance, uniting the parts of the body, the 

cells of which are reservoirs for fat. 
Cen-trif 'u-gal, Tending to recede from the centre. 
Ceph-al-al'gia, The headache. 

Cer-e-bel'lum, The hinder and lower part of the brain, or the little brain. 
Oer'e-brum, The front and larger part of the brain. 
Ce-re'bri-form, Like the brain. 
Cer'e-bral, Pertaining to the brain. 



984 GLOSSARY. 

Cer'e-bro-Spi-nal Centres, The brain and spinal marrow. 

Cer'e-bri-tis, Inflammation of the brain. 

Cer'vix, The neck of the womb. 

Cha-lyb'e-ate, Any water or other liquor into which iron enters. 

Chan' ere, A venereal ulcer. 

Charl'a-tan, A quack; one who makes unwarrantable pretensions to skill. 

Cha'ry, Careful; fearful. 

Chlo'rate, A compound of chloric acid with a salifiable base. 

Chlo'rate of Ba'ri-um, A combination of chloric acid and barium. 

Chlo'rate of Cal'ci-um, A compound of chloric acid and calcium. 

Chlo-ro'sis, The green sickness. 

Chlo-rot'ic, Affected by or pertaining to chlorosis. 

Chol'er-ic, Inclined to anger ; easily irritated. 

Chol'er-a, A disease attended by violent vomiting and purging. 

Chol'a-gogue, A medicine for producing bilious discharges. 

Cho-re'a, St. Vitus's Dance. 

Chol'er-ine, A mild form of cholera. 

Chyle, A white or milky fluid prepared from the chyme. 

Chy-li-fi-ca'tion, The act or process by which chyle is formed. 

Chy-lo-po-et'ic Vis'ce-ra, The organs of digestion. 

Chyme, The food after it has been digested and passed from the stomach 

into the bowels. 
Chym'i-fied, Formed into chyme. 
Chron'ic, Of long continuance, as a chronic disease. 
Ci-ca'trix, A scar remaining after a wound or ulcer is healed. 
Cic'a-trize, To heal, or induce the formation of a cicatrix. 
Cin-cho'na, The Peruvian bark, from which quinine is made. 
Cir-cu-la'tion, The act of moving round, as the circulation of the blood. 
Cir'cu-la-to-ry, Circular; circulating. 
Clani'my, Thick ; sticky ; glutinous. 
Clav'i-cle, The collar-bone. 

Clin'i-cal, A description of disease given at the bedside of the patient. 
Clon'ic, Shaking; convulsive, as clonic spasm. 
Clys'ters, Injections. 

Co-ag'u-late, To curdle or congeal; to thicken. 
Co-ag'u-la-ble, That may be congealed or made solid. 
Co-ag'u-lum, A congealed mass, as curd ; a clot of blood. 
Co-a-lesce', To unite and adhere in one body or mass. 
Coc'cyx, A small bone at the lower extremity of the os sacrum; the 

crupper bone. 



GLOSSARY. 985 

Co-ex-ist ; ing, Existing at the same time with another. 

Col-laps'ed, Fallen together, as the fine canals or vessels of the body. 

Col-liq'ua-tive, Melting; dissolving; wasting the strength of the body. 

Col-lat'e-ral, Side by side, as a medicine to aid another. 

Col-lyr'i-um, A lotion or wash for the eye. 

Co'lon, The largest division of the intestinal canal. 

Co lo'di-an, Gun-cotton dissolved in ether. 

Oo-li'ca Pic-to'num, Lead colic. 

Co'ma, Profound lethargic sleep or stupor 

Co'ma-tose, Morbidly sleepy ; lethargic. 

Com'press, A bolster of soft linen cloth or cotton, used in dressing 

wounds. 
Con-cat-e-na'tion, A series of links united, as a concatenation of causes. 
Con'cave, Hollow, and arched or rounded, as the inner surface of a 

spherical body. 
Con-ceive', To become pregnant. 
Con-cep'tion, The act of conceiving. 
Con-ces'sion, The act of granting or yielding. 
Con-com'i-tant, Accompanying; conjoining with; attending. 
Con'crete, To coalesce into one mass ; to unite. 

Con'di-ment, Seasoning; sauce; that which is used to give relish to food. 
Con'dyle, A protuberance, or the end of a bone ; a knot ; a knuckle. 
Oon'flu-ent, Running together, and spreading over a large surface of the 

body. 
Con-geal', To grow hard, stiff, or thick, from loss of heat. 
Con-ges'tion, An unnatural accumulation of blood in any part of the 

body. 
Con-glo'bate, To form into a ball or hard round substance. 
Con-glom'er-ate, To collect into a round mass. 
Oon'i-cal,. Round and decreasing to a point. 
Co-ni'um, The hemlock. 

Con-junc'tion, Union ; connection; association. 
Con'sti-pa-ted, Made costive. 

Oon-sti-pa'tion, A crowding or filling to hardness the intestinal canal. 
Con-stit'u-ents, Materials of which a part is composed. 
Con-ta'gion, Deleterious exhalations ; infectious matter. 
Con-ta'gious, Catching; that maybe communicated by contact. 
Con-tig'u-ous, Touching; meeting; joining at the surface or border. 
Con-ti-nu'i-ty, Uninterrupted connection ; close union of parts. 
Oon-tract-i-bil'ity, Quality of suffering contraction or lessening. 



986 



GLOSSARY. 



Con-tract'ing, Lessening in dimensions; shrinking. 

Con-tra-in'dicated, Not indicated; not proper. 

Con-tuse', To beat, to bruise. 

Con-tu'sion, The act of bruising, or state of being bruised. 

Con-tor'tion, A twisting or wresting a member of the body from its 
right place. 

Con-tri'tion, The act of grinding or rubbing to powder. 

Con-va-les'cence, The state of a body renewing its vigor after sickness. 

Con' vex, The exterior surface of a spherical body; opposed to concave. 

Con-vul'sion, Violent contraction of the muscles. 

Con-vul'sive, Attended with convulsions or spasms; that produces con- 
vulsions. 

Cor'pus-cles, Small particles or bodies that compose large ones. 

Cor-po're-al, Material; opposed to spiritual, as our corporeal frame. 

Cor'dial, That which increases strength and raises the spirits. 

Corn'e-a, The transparent membrane in the fore part of the eye through 
which the rays of light pass. 

Cor-rob'o-rant, A medicine that strengthens; strengthening. 

Cor-ro'sive, Eating; consuming; as aquafortis. 

Cor'ti-cal, Belonging to the external covering. 

Cor'i-on, A membrane lining the womb in pregnancy. 

Co-ry'za, Cold in the head; copious running from the nose. 

Co'pi-ous, Abundant; plentiful. 

Cos-met'ie, That which improves the complexion. 

Couch' ed, Pressed down. 

Coo'ing, Uttering a low sound, as a dove. 

Coun'ter-Ir-ri-ta'tion, Irritation produced in another part. 

Cra'ni-um, The skull. 

Cra'ni-al, Pertaining to the skull. 

Crap'u-lous, Drunk; sick by intemperance. 

Cre'dence, To believe; to credit. 

Crep'i-tis, Small crackling noise. 

Cres'cent, The figure of the new moon. 

Cres-cen'tic, Shaped like a crescent; pertaining to a crescent. 

Cre' ten-ism, Deformed; idiotic. 

Cre-ta'ce-ous, Chalky; abounding with or having the qualities of chalk. 

Cri-te'ri-on, Rule ; principle ; a standard of judging. 

Cri'sis, That change of a disease which indicates recovery or death. 

Cru'ral, Belonging to the leg. 

Crural Nerve, The nerve of the leg. 



GLOSSARY. 987 

Cu'li-na-ry, Relating to the kitchen, or art of cookery. 

Cu'ra-tive, Tending to cure. 

Cu-ta'ne-ous, Belonging to the skin; existing on the skin. 

Cu'ti-cle, The exterior coat of the skin which rises in blisters. 

Cu-tic'u-lar, Pertaining to the cuticle or scarf-skin. 

Cyst, A bag, or tunic, including morbid matter in animal bodies. 

Cys-ti'tis, Inflammation of the bladder. 

De-bauch', Excess in eating or drinking; drunkenness. 

De-bil'i-ty, Weakness; feebleness. 

De-bil'i-tants, Medicines that reduce strength. 

De-bris', Cast-off material. 

De-cant', To pour off gently, as liquor from sediment. 

De-cid'u-ous, Falling ; having but a temporary existence. 

De-coc'tion, A liquor in which a substance has been boiled. 

Def-e-ca'tion, Purification ; to purge. 

Deg-lu-ti'tion, Act of swallowing. 

Del-e-te'ri-ous, Destructive; injurious. 

De-lir'i-ous, Disordered in intellect ; wandering in mind. 

De-lir'i-um, A disorder of the intellect connected with fever. 

Del'toid, A term applied to a muscle of the shoulder. 

De-jec'tion, A casting down; depression of spirits. 

De-men'tia, Loss of mind ; idiocy. 

De-mul'cent, Softening; medicine which softens and mollifies. 

De-nai/cot-ized, Deprived of narcotic power. 

De-nud'ed, Laid bare ; deprived of skin ; naked. 

Den-ti'tion, Teething; cutting teeth. 

Dens'er, More compact; more solid. 

De-pend'ent, Hanging down. 

De-plete', To lessen in quantity, as blood; to weaken. 

De-ple'tion, The diminishing the quantity of blood by blood-letting. 

De-ple'to-ry, Calculated to weaken and obviate fulness of habit. 

De-ple'tive, Causing weakness ; reducing. 

Dep're-cate, To pray against ; to regret. 

De-prave', To impair that which is good ; to corrupt ; to taint. 

Dep'u-rate, To free from impurities. 

Des-qua-ma'tion, Scaling off. 

Di-a-be'tes, Morbid discharge of sweet urine. 

Di-ag-no'sis, The art of distinguishing one disease from another. 

Di-ag-nose', The act of distinguishing diseases. 



988 GLOSSARY. 

Di-ag-nos'tic, Distinguishing. 

Di-a-pho-ret'ic, Promoting perspiration ; that which sweats. 

Di-a-pho-re'sis, Increased perspiration or sweating. 

Di'a-phragm, The muscular partition between the chest and abdomen. 

Di-ar-rhoe'a, A watery purging of the bowels. 

Di-as'to-le, A dilation of the heart, auricles, and arteries. 

Di-ath'e-sis, A particular habit or disposition of body. 

Di-e-tet'ic, Pertaining to diet, or the rules for regulating the quantity and 

kind. 
Di-ges'tion, The process of decomposing food in the stomach, and reconi- 

posing it in a new form, and thus preparing it for circulation and 

nourishment. 
Dig-i-ta'lis, The plant called foxglove. 

Dil-a-ta'tion, The act of expanding, spreading, or extending. 
Dil'u-ents, Bland drinks. 
Di-lute', To thin ; to weaken. 

Di-lu'tion, The act of making more liquid ; weakening. 
Dim-i-nu'tion, The act of lessening or making smaller. 
Dis-in-te-gra'tion, Separation of the composing particles of a body. 
Dis'lo-cate, To put out of place ; to disjoint. 
Dis-sect', To cut in pieces. 

Dis-tend, To stretch or spread in all directions ; to dilate ; to swell. 
Di-u-re'sis, Excessive flow of urine. 

Di-u-ret'ic, Medicine that increases the discharge of urine. 
Di-urn'al, Daily ; happening every day. 
Do'lor, Pain ; grief; lamentation. 
Dom'in-ant, Prevailing ; governing; predominant. 
Dor'sal, Pertaining to, belonging to the back. 
Douche, A jet or current of water directed with considerable force upon 

the body. 
Dras'tic, Powerful ; active purgation. 
Draught, Quantity drank at once. 

Drop'sy, An unnatural collection of water in any part of the body. 
Duct, A tube to convey a fluid in an animal body. 
Dul'ca-ma-ra, Bitter-sweet. 

Du-o-de'num, The first of the small intestines; the twelve-inch intestine. 
Du-o-de'nal, Belonging to the duodenum. 
Du-o-den'i-tis, Inflammation of the duodenum. 
Du'ra-Ma'ter and Pi'a-Ma'ter, Membranes of the brain. 
Dys-pep'si-a ; Bad digestion ; difficulty of digestion. 



GLOSSARY. 989 

Dys-pep'tic, Afflicted with bad digestion ; a person so afflicted. 
Dysp-noe'a, Difficulty of breathing. 
Dys-men-or-rhoe'a, Painful and difficult menstruation. 
Dys'u-ria, Difficulty and pain in discharging urine. 

Ec-cen-tric'i-ty, Deviation from that which is regular or usual; singu- 
larity. 

Ec-chy-ino'ses, Tumors or livid spots on the skin, occasioned by an effu- 
sion of blood. 

Ec-thy'ma, To rage; a cutaneous eruption. 

Ec-ze'ma, A hot and painful eruption or pustule. 

Ed'i-ble, Fit to be eaten as food ; eatable. 

E-dem'a-tous, Full of humors ; swelling ; dropsical. 

Ef-fer-ves'cence, That commotion of a fluid which takes place when some 
part of the mass flies off in a gaseous form, producing innumerable 
small bubbles. 

Ef-fete', Barren ; worn out with age. 

Ef-flo-res'cence, A redness of the skin ; eruptions, as rash, measles, etc. 

Ef-flu'vi-a, Noxious vapors. 

Ef-fuse', To pour out; to spill. 

Ef-fu'sion, The act of pouring out, as a liquid. 

E-lab-o-ra'tion, Improvement by successive operations. 

E-lic'it, To draw out ; to deduce by reason or argument. 

E-lim'i-na-ted, Expelled ; thrown off; discharged. 

E-ma'ci-ate, To cause to waste flesh and reduce to leanness. 

E-ma-ci-a'tion, The act of wasting away and becoming lean. 

Em'e-sis, Vomiting. 

E-met'ic, Medicine that causes vomiting. 

Em'bro-cate, To moisten and rub a diseased part with a liquid substance 

Em-bro-ca'tion, The act of moistening, as with a sponge dipped in liquid 

E-mol'li-ent, Softening; relaxing. 

E-mit', To send forth ; to throw or give out. 

Ein-men'a-gogue, A medicine that promotes the menstrual discharge. 

Em-pir'i-cism, The practice of medicine without a medical education. 

Em-py-e'ma, A collection of blood or pus in some cavity of the body, 
particularly of the thorax. 

Em-py-reu-mat'ic, Having the smell and taste of burnt substances. 

E-mulg'ent, A term applied to the blood-vessels of the kidneys. 

E-mul'sion, Any milk-like mixture prepared by uniting oil and water by 
means of another substance. 



990 



GLOSSARY. 



E-munc'to-ries, Excretory ducts serving to carry off excrenientitious 

matter. 
En-am'el, The outside covering of the teeth. 
En-ce-phal'i-tis, Inflammation of the brain. 
En-ceph'a-loid, Like the brain. 
En-dem'ic, A disease peculiar to certain districts. 
En-do- carditis. Inflammation of the lining membrane of the heart. 
En-e'ma — En-e-ma'ta — Injections. 
E-nerv'ate, Weakened; deprived of nerve-power. 

En-gorge'ment, An accumulation and stagnation of the fluids in a part. 
En-sue', To follow. 
En-ter'ic, Pertaining to the bowels. 
En-ter'i-tis, Inflammation of the bowels. 
En'ti-ty ; Being ; existence ; a real being. 
En-u-re'sis, Involuntary discharge of urine. 
E-phem'er-al, Diurnal ; beginning and ending in a day ; a fever of one 

day's continuance. 
Ep-i-dem'ic — Ep-i-dem'ic-al — Generally prevailing; affecting great num 

bers. 
Ep-i-derm'is, The outer skin. 

Ep-i-gas'tric 7 Pertaining or belonging to the pit of the stomach. 
Ep-i-gas'tri-um, Pit of the stomach. 
Ep-i-glot'tis, A cartilage which prevents the food from entering the 

larynx and obstructing the breath. 
Ep-is-pas'tic, Drawing; blistering. 
Ep-i-lep'tic, Diseased with epilepsy ; convulsed. 

Ep-i-lep'sy, A disease in which the patient falls suddenly with spasms. 
Ep-i-lep'tic Au'ia, A peculiar sensation often experienced before an 

attack of ep.lepsy. 
E'pis-tax-is, Bleeding at the nose. 
Ep-i-the'li-um, Scarf-skin. 

E-pi-the'li-al, Relating or belonging to or like the scarf-skin. 
E'qual-ize, To make equal. 

E'qua-ble, Even ; smooth ; equal and uniform at all times. 
E-qui-lib'rium, Equality of weight or force ; equal balance. 
E-ra'sion, A rubbing out ; obliteration. 
Er-rat'ic, Wandering; moving; irregular. 
E-rec'tile, That which may be erected ; state of being erect. 
Er'u-dite, Learned. 
Er-u-di'tion ; With knowledge gained from books and instruction. 



GLOSSARY. 991 

Er-uc-ta'tion, The act of belching wind from the stomach. 

E-rup'tion, A breaking out of humors in pustules. 

Er-y-sip'e-las, St. Anthony's fire. 

Er-y-si-pel'a-tous, Eruptive ; resembling or partaking of the nature of 

erysipelas. 
Er-y-the'ma, An inflammation of the skin. 
Er-y-the-mat'ic, Denoting a morbid redness of the skin. 
Es'char, The crust or scab occasioned by burns or caustic applications. 
E-the're-al, Consisting of ether or spirit ; thin ; light ; subtile. 
Eu-sta'chi-an Tube, A slender pipe affording a passage for the air from a 

cavity in the ear to the back part of the mouth. 
E-vac'u-ant, A medicine which procures evacuations. 
E-vac'u-a-ted, Emptied ; freed from the contents ; discharged. 
E-vac-u-a'tions, Discharges by stool or other natural means. 
E-vap-o-ra'tion, The conversion of a fluid into vapor or steam. 
Ex-ac-er-ba'tions, Paroxysms ; periodical increase of violence in a disease. 
Ex-alt-a'tion, Increase of the strength, or refinement of the virtues, of 

bodies. 
Ex-an-the'ma, An eruption accompanied by fever. 
Ex-an-them'a-ta, Plural of Exanthema. 
Ex-an-them'a-tous — Ex-an-the-mat'ic — Eruptive; morbid redness of the 

skin. 
Ex-cise', To cut off. 

Ex-cis'ion, A cutting out or off any part of the body. 
Ex-co'ri-ate, To break or remove the skin by rubbing or beating. 
Ex-co-ri-a'tion, Act of galling ; state of being stripped of skin. 
Ex'cre-ments, Discharges from the bowels. 
Ex-cre-inen-ti'tious, Pertaining to or containing excrement. 
Ex-cres'cence, A superfluous or unnatural part, as a wart or tubercle. 
Ex-cre'tion, Throwing off of matter no longer useful from the body. 
Ex'cre-to-ry, Quality of separating and throwing off superfluous parts. 
Ex-cru r cia-ting, Torturing; extremely painful. 
Ex-fo'li-ate, To separate and come off in scales. 
Ex-hale', To send out; to emit, as vapor or minute particles of a fluid 

or other substance. 
Ex-ha'lant, Having the quality of evaporating. 
Ex-ha-la'tion, Act or process of evaporation ; that which is exhaled or 

emitted. 
Ex-hib'it, To administer as medicine. 
Ex-hi-bi'tion, The act of administering a remedy. 
63 



992 GLOSSARY. 

Ex-os-to'sis, An unnatural enlargement of a bone, or excrescence. 

Ex-pec' to-rant, A medicine which promotes discharges from the lungs. 

Ex-pec' to-rate, To discharge phlegm or other matter, by coughing, hawk- 
ing, and spitting. 

Ex-pec-to-ra'tion, Act of discharging phlegm or mucus from the lungs ; 
also the matter thus discharged. 

Ex-tens'or, A muscle which serves to extend or straighten any part of the 
body, as an arm or a finger. 

Ex-tir-pa'tion, Total destruction ; act of rooting out or eradicating. 

Ex-trav'a-sa-ted, Forced or let out of its proper vessels, as extravasated 
blood. 

Ex-tra'ne-ous, Not belonging to a thing. 

Ex-ude', To discharge the moisture or juices of a living body through the 
pores of the skin. 

Ex-u-da'tion, A sweating ; a discharge of the moisture of the body. 

Fse'ces, Excrements. 

Fal-lo'pi-an Tubes, Two tubes or ducts arising from the womb, discovered 

by Fallopius. 
Far-i-na'ce-ous, Consisting or made of meal or flour; mealy. 
Fas'ci-a, A bandage ; a thin tendinous covering surrounding and binding 

the muscles in their places. 
Fa-tu'i-ty, Feebleness of intellect; foolishness. 
Fau'ces, The back part of the mouth terminating in the throat. 
Fa'vose, Like the section of a honeycomb. 
Feb'ri-fuge, Medicine that mitigates or removes fevers. 
Fe'brile, Relating to or indicating fever, or derived from fever. 
Fe'cal, Containing or consisting of excrements. 
Fec'u-lent, Foul with impure substances. 
Fet'id, Having an offensive smell, strong or rancid scent. 
Fe'tor, Stench ; offensive smell. 
Fem'o-ral, Belonging to the thigh. 
Fe'mur, The thigh-bone. » 

Fer-ru'gi-nous, Partaking of iron ; containing particles of iron. 
Fi'bre, Any fine slender thread. 

Fi'brin, A peculiar organic substance found, in animals and vegetables. 
Fi'brous, Composed or consisting of fibres. 
Fi'bro-Car-ti-lag'i-nous, Consisting of fibres and cartilage. 
Fi-na'le, Close; termination; end. 
Fis'tu-la ; A deep tube-like ulcer. 



GLOSSARY. 993 

Fis'sure, A crack or slit., or depression. 

Flac'cid, Soft and weak; limber; yielding. 

Flac-cid'i-ty, State of being yielding ; soft ; limber. 

Flat'u-lence — Flat'u-len-cy — Affected with wind in the stomach and 

intestines. 
Flat'u-lent, Windy; turgid with air. 
Fla'tus A breath ; a puff of wind ; wind in the stomach. 
Flexed, Bent, as a limb in a flexed position. 
Flex'i-ble, That may be bent; not stiff; yielding to pressure. 
Flex'ion, Act of bending ; a part bent. 

Flex'or, A muscle whose office it is to bend the part to which it belongs. 
Flex'ure, The part bent; a joint; the form of bending. 
Flor'id, Bright with color; flushed with red. 
Flooding, An unnatural discharge of blood from the womb. 
Flu'id-ounce, An ounce by measure ; the twelfth part of a pint. 
Fce'tus, The child in the womb. 

Fol'li-cle, A gland ; a little bag in animal bodies ; a folding ; a cavity. 
Fol-lic'u-lar, Relating to follicles. 
Fo-ment-a'tion, A partial bathing by the application of flannels dipped in 

liquids. 
Font'a-nels, The openings in a child's head. 
Fo-ra'men, A little opening; a perforation. 
For-mi-ca'tion, A sensation as of ants creeping over the skin. 
Form'u-la, A prescription ; a prescribed form ; a rule or model. 
Fos'sa, A kind of cavity in a bone, with a large aperture. 
Frac'ture, A broken bone ; to break or crack. 
Fren'zy, Distraction; madness; violent agitation of the, mind. 
Fric'tion, The rubbing of the body with the hand, or brush, flannel, 

etc. 
, Fri'a-ble, Easily crumbled or pulverized, or reduced to powder. 
Frig-o-rif 'ic, Producing or generating cold. 
Front'al Si'nus, A cavity between the two plates of the skull above 

the eye. 
Fu'mi-ga-ted, Smoked ; exposed to smoke. 
Fu-mi-ga'tion, Act of smoking ; vapors ; scents raised by fire. 
Func'tion, The action or office performed by an organ. 
Func'tion-al, Pertaining to functions ; performed by functions. 
Fun'dus, Upper portion of the womb. 
Fun'gus, Proud flesh ; any morbid excrescence. 
Fur-fu-ra'ceous, Scaly; branny; scurfy. 



994 GLOSSARY. 

Fu'si-form, Shaped like a spindle. 
Fu'tile, Of no effect; worthless. 

Gan'gli-on, A natural enlargement in the course o*.a nerve 

Gan-gli-on'ic Sys'tem, Nerves of organic life. 

Gan'glia, The plural of ganglion. 

Gan'grene, Mortification of living flesh, or of some part of a living 

animal body. 
Gar'gle, A wash for the mouth and throat; to wash the mouth and throat. 
Gas, A permanently elastic aeriform fluid, invisible except when colored. 
Gas'e-ous, In the form of gas or an aeriform fluid. 
Gas'tric, Belonging to the stomach. 
Gas-tri'tis, Inflammation of the stomach. 
Gas'tro-In-ter'i-tis, Inflammation of the stomach and bowels. 
Gas-tral'gia, Neuralgia of the stomach. 
Ge-lat'o San-guin'e-ous, Composed of gelatine and blood. 
Gen'i-tals, Organs employed in generation. 
Gen'i-tal Fis-sure,- Orifice of the vagina ; birthplace. 
Ges-ta'tion, The act of carrying young in the womb from conception to 

delivery. 
Gland, A secretory organ, in some cases very small, in others large, like 

the liver. 
Gland'u-lar, Containing glands; consisting of glands; pertaining to 

glands. 
Glob'ule, A small particle of matter, of a round or spherical form. 
Glo'bous Hys-ter'i-cus, The sensation of a globe or ball in the throat. 
Glot'tis, The narrow opening at the upper part of the windpipe. 
Glu'tin-ous, Gluey; sticky; tenacious. 
Glyc'e-rin, A transparent liquid, without color or smell, of a syrupy 

consistence. 
Gon-or-rhce'a, A morbid running of venereal taint. 
Grad'u-ate, To divide any space into small regular intervals. 
Gran-u-la'tion, The act of forming into grains ; the grain-like eminences 

on a healing surface. 
Gran'ules, Small particles; little grains. 
Grav'id, Pregnant. 

Gro-tesque', Of irregular forms and proportions; fantastical. 
Gru'nious, Thick; clotted; concreted. 
Gust'a-to-ry, Relating to the taste. 
Gym-nas'tic ; Exercises of the body intended for health. 



GLOSSARY. 



995 



Hab'i-tude, Custom ; habit ; customary manner or mode of life. 

Hal-lu-cin-a'tion, Error; delusion; mistake. 

Half-pack, A cold wet sheet folded and laid over the body and covered 

with a dry one. 
Hae-mat-e-me'sis, Vomiting of blood. 
Hse-mat-u'ria, Voiding bloody urine. 
Hae-mop'ty-sis, Bleeding from the lungs. 
Hem-i-cra'nia, A pain that affects but one side of the head. 
Hem-i-ple'gi-a, A palsy that affects one half of the body. 
Hem'or-rhage, A discharge of blood, as from a ruptured blood-vessel. 
Heni'or-rhoids, The piles. 
He-pat'ic, Pertaining to the liver. 
He-pat'i-tis, Inflammation of the liver. 
Herb-iv'o-rous, Feeding on vegetables, as the ox and horse. 
He-red' it-a-ry, That has descended from an ancestor. 
Her-met'ic-al-ly, Closely; accurately. 
Her'pes, Tetters; an eruption of the skin. 
Her-pet'ic, Pertaining to herpes or eruptions of the skin. 
Her'ni-a, A protrusion of some organ of the abdomen; a rupture. 
Het'e-ro-dox, Contrary to truth and fixed principles. 
Ho-mo-ge'ne-ous, Of the same kind or nature. 
Hu'mid, Moist ; damp ; containing sensible moisture. 
Hu-mid'ity, A moderate degree of wetness ; moisture in the form of 

visible vapor. 
Hyd'a-ted, An animal existence having the appearance of a bladder of 

water. 
Hy-drar'ge-ri Sub-mu'ri-as, Calomel. 
Hj'dra-gogue, A purge producing watery stools. 
Hy'dro-cele, Dropsy of the scrotum. 
Hy-dro-ceph'a-lus, Dropsy of the head or brain. 
Hy-dro-cy-an'ic, A term applied to an acid. 
Hy-dro-path'ic, Pertaining to hydropathy, or the curing of diseases with 

water only. 
Hy-dro-per-i-car'di-um, Dropsy of the heart. 
Hy-dro-pho'bi-a, Dread of water. 
Hy-dro-tho'rax, Dropsy in the chest. 
Hy-gi-en'ic, Pertaining to health. 

Hy-gro-met'ri-cal, Readily absorbing and retaining moisture. 
Hy-os-cy-a'mus, Henbane. 
Hy-pat'i-tis, Inflammation of the liver. 



996 GLOSSARY. 

Hy-per-ca-thar'sis, Over-purging. 

Hy-per'tro-phy, Morbid enlargement of a part of the body from over 
nourishment. 

Hyp-o-chon'dri-a, The region of the liver. 

Hyp-o-chon-dri'a-sis, A disease characterized by low spirits and melan- 
choly. 

Hy-po-gas'tri-uni, Space between the last rib and the hip. 

Hy-poth'e-sis, Something assumed for the purpose of argument; a sup- 
position. 

Hy-po-thet'ic-al, Conditional; assumed without proof. 

Hys-ter'ics — Hys-te'ri-a — A disease characterized by convulsive strug- 
gling; sense of suffocation; temper fickle. 

I'chor-ous, Thin; watery; undigested. 

Ich-thy-o'sis, A roughness of the skin which becomes thick, hard, and 

scaly. 
Id-i-o-path'ic, Primary; independent of other diseases. 
Id-i-o-syn'cra-sy, Any peculiar habit or disposition of body. 
Id'i-o-cy, A defect of understanding; foolishness. 
Il-i'i, Wings forming the upper part of the pelvis. 
Il'i-ac, Pertaining to the lower bowels or ilium. 
Il'i-us, Colic in the small intestines. 
Il'i-um, A division of the small intestines. 
Il-i-o-Coe'cal, Belonging to the small and first large bowels. 
Il-lu'so-ry, Deceiving or intending to deceive by false appearances. 
Im-be-cil'ity, Feebleness of body and mind; weakness. 
Im-mo-bil'i-ty, Fixedness in place or state ; immovableness. 
Im-per'fo-rate, Having no opening; not perforated or pierced. 
Im-per'vi-ous, Not to be penetrated or passed through. 
Im'pe-tus, Force of motion. 
Im-pe-ti'go, An eruption of the skin, consisting of pustules, clustering, 

yellow, and itching. 
Tm-put'ed, Charged to the account of; attributed; ascribed. 
In-cep'tion, Beginning. 

In-cip'i-ent, Commencing, as the incipient stage of fever. 
Tn-cise', To gut in; to carve. 
In-cised', Made by cutting; as an incised wound. 
In-cis'ion, A cut; a gash. 

In-con'ti-nence, Want of restraint; inability to restrain or prevent. 
In-crus-ta'tion, A coat or crust on the surface of a body. 



GLOSSARY. 997 

In-cu-ba'tion, The act of sitting on eggs for the purpose of hatching 

young. 
In-du-ra'tion, Obduracy ; stubbornness ; hardness ; process of hardening. 
In-dig'en-ous, Native ; produced naturally in a country. 
In-dis-po-si'tion, Tendency to disease ; slight disorder ; not inclined to. 
In-ert', Not active ; destitute of power. 

In-ert'ness, State of being inactive ; quality of being destitute of power. 
Jn-ex'pli-ca-ble, That cannot be explained or interpreted. 
In'fant-ile, Pertaining to infancy ; first period of life. 
In-fe'ri-or Half, Lower half. 
In-fest'ing, Disturbing; annoying. 
In-fil'tra-ted, Passed through a porous substance. 
In-fin-i-tes'i-mal, Infinitely small. , 
In-flam-ma'tion, Redness and swelling of a part, attended with heat and 

pain. 
In-flat'ed, Swelled or distended ; puffed up. 
In-fu'sion, The act of pouring in ; the liquor in which herbs have been 

steeped. 
In-fu-so'ri-a, Microscopic animals and insects inhabiting water. 
In-gest'a, Food. 

In'gress ; Having access into ; entrance ; power of entering. 
In-hale', To draw into the lungs. 
In-her'ent, Possessed naturally ; not acquired. 
In-ject', To throw in. 
In-ject'ed, Thrown in. 
In-jec'tion, The act of throwing in; a liquid medicine thrown into the 

body by a syringe or pipe. 
In'nate, Inborn ; native ; natural. 
In-nerv-a'tion, Nerve power. 

In-oc'u-late, To insert contagious matter in the flesh. 
In-or'din-ate, Irregularly ; disorderly ; immoderately. 
In-or-gan'ic, Not formed with the organs or instruments of life. 
In-nom-e-na'ti, Side bones of the pelvis. 

In-seru'ta-ble, Unsearchable ; that cannot be penetrated or understood. 
In-so-la'tion ; Exposure to the sun ; action of extreme heat on the living 

system. 
In-sol'u-ble, That cannot be dissolved, especially in water. t 

In-sol-u-bil'i-ty, Quality of not being soluble in a fluid. 
In-spis'sa-ted, Thickened as a liquor. 
In-teg'u-ment, A covering that invests the body, as the skin. 



998 GLOSSARY. 

In-ter-cos'tal, Placed or lying between the ribs. 

In'ter-im, The meantime; time between events. 

In-ter-la'cing, Intermixing ; inserting between. 

In-ter'i-tis, Inflammation of the small intestines. 

In-ter-mit'tent, Ceasing at intervals and then returning. 

In-ter-mit'ting, Ceasing for a time; causing to cease. 

In-ter-Os'se-ous, Situated between bones. 

In'ter-sti-ces, Spaces between things. 

In-tes'tin-al, Pertaining to the intestines. 

In-tol'er-ance, The not enduring at all. 

In-tro-ver'sion ; The act of turning or state of being turned inwards. 

In-tus-sus-cep'tio, The reception of one part within another. 

In-unc'tion, The action of anointing. 

In-vet'er-a-cy, Long continuance ; firmness ; obstinacy. 

In-ver'sion, Turned inside out ; changed in order. 

In-vest'i-tures, Surroundings ; that which invests, as the skin. 

In-vest'ing, Surrounding closely; enclosing. 

In-vig'or-a-ted, Strengthened; animated. 

In-vol'un-ta-ry, Not voluntary ; contrary to the will. 

I-ras'ci-ble, Easily provoked ; hasty ; passionate. 

Ir'ri-tant, That which excites and inflames. 

I'ri-tis, Inflammation of the iris, or curtain of the eye. 

Is-chu'ria, A stoppage or suppression of urine. 

Is-chu'ria Re-na'lis ; Suppression of the urine. 

Is-chi'i ? Lower part of the pelvis. 

Is'o-la-ted, Separated; detached. 

Jac-ti-ta'tion, Restlessness of the body. 

Je-ju'num, The small intestines comprised between the duodenum and 

ilium. 
Ju'gu-lar ; A large vein in the neck. 

Lac'er-ate, To tear; to rend. 

Lach'ry-mal, Generating or secreting tears; conveying tears. 

Lac'te-als, Vessels containing chyle. 

Lac ta'tion, The act of suckling; the time of suckling. 

Lac-tu-ca'ri-um, The concentrated juice of the common lettuce, used as a 

substitute for opium. 
Lam'in-ae, Plates of bones. 
Lam'in-a-ted, Plated ; consisting of layers. 



GLOSSARY. 999 

Lan'ci-nate, To tear; shooting pains. 

Lapse, To glide ; to pass slowly, silently, or by degrees. 

La-ryn'ge-al, Pertaining to the larynx. 

La-ryn-gi'tis, An inflammation of the larynx. 

Lar'ynx, The upper part of the wind-pipe or trachea. 

Las'si-tude, "Weariness; dulness; languor. 

Lat-er-i'tious, Of the color of bricks; applied to sediment deposited in 

urine. 
La'ten-cy, State of being concealed; not perceptible. 
Lat'er-al Half, One side. 

Lax'a-tives, Medicines that relax the bowels and relieve costiveness. 
Leth'ar-gy, Morbid sleepiness; dulness. 
Len'tor, Tenacity; viscidity; thickness of fluids; sizy or viscid humors 

in the blood. 
Leu-cor-rhoe'a, The whites. 
Le'sion, A hurting; wound; injury. 
Lig'a-ture, A band or bandage ; a cord or string. 
Lin'iment, A thin soft ointment. 
Lim'pid, Pure; clear; transparent. 

Li-thot'o-my, The art or practice of cutting for stone in the bladder. 
Lith'i-a-sis, Stone in the bladder or kidneys. 
Liq'uor Am-nii, The waters of the foetus. 
Liv'id, Black and blue. 

Lo-chi'a, Evacuations which follow childbirth. 
Lo-co-mo'tion, The act or power of moving from place to place. 
Lo'tion, A liquid preparation for washing some part of the body. 
Lu'bri-cate, To make smooth or slippery. 

Lum-ba'go, A rheumatic affection of the muscles about the loins. 
Lum'bar Ver'te-bra, The bones forming the small of the back. 
Lu-es Ve-ne-rea, Syphilis. 

Lymph, A colorless fluid in animal bodies, contained in the lymphatics. 
Lym-phat'ics, Vessels which carry white fluids. 

Mac'er-ate, To soften and separate the parts of a substance by steeping it 

in a fluid, or by the digestive process. 
Mag-ne'sia cum Po-tas'sae, Magnesia and potash. 
Ma-la'ri-a, Bad air ; that species of air that produces or tends to produce 

disease. 
Ma'laise, A general bad state of the system. 
Ma-lain'a ; Depravity of the blood ; a tendency to putrefaction. 



1000 GLOSSARY. 

Ma-lig'nant, Dangerous to life. 

Ma-lig'ni-ty, Destructive tendency; virulence. 

Mal-con-form-a'tion, 111 form; disproportion of parts. 

Mal-form-a'tion, Irregular or wrong formation. 

Mam-mse', The breasts. 

Mam'ma-ry Grland, Pertaining to the breasts. 

Ma'ni-a, Madness; derangement. 

Ma'ni-a-a-Potu, Madness from drinking; delirium tremens. 

Mas'si-ter, The main muscle of the jaw. 

Mas'ti-cate, To chew. 

Ma-tu'ri-ty, Of full ripe age. 

Max'il-la-ry Si'nus, A cavity in the upper jaw. 

Me-a'tus, An opening which leads to a canal or duct. 

Med'ic-a-ment, A medicine; a healing application. 

Med'ic-a-ted, Prepared or furnished with medicine. 

Me-dul'la Spi-nal'is, Spinal marrow. 

Med'ul-la-ry Sub-stance, Brain matter. 

Me-lae'na, Hemorrhage from the bowels. 

Mel'ior-ate, To make better; to improve. 

Mem'brane, A thin white flexible skin ; a web of fibres. 

Mem'bra-nous, Consisting of membranes. 

Men-stru-a'tion, The act or process of menstruating or discharging the 

menses. 
Men'ses, Monthly courses of females. 
Men-or-rha'-gia, Hemorrhage from the womb. 
Me-nin'ge-al, Pertaining to the investing membranes of the brain. 
Me-nin'gi-tis, Inflammation of the investing membrane of the brain. 
Mes'en-ter-y, A fatty membrane connecting the intestines. 
Me-tas-ta'sis, A translation of a disease from one part to another. 
Me-tal'lic Trac'tors, Fine metallic points, which by being applied to a 

part were supposed to extract pain. 
Me-thod'ic-al, Arranged in convenient order ; regularly disposed. 
Mi-as'ma, Infecting poisonous substances floating in the air. 
Mi-as-mat'ic, Partaking of the qualities of poisonous effluvia; bilious. 
Mi-cro-scop'ic, Very small ; visible only by the aid of a microscope. 
Mic-tu-ri'tion, Act of passing urine. 
Miin'ic, To imitate ; one who imitates. 
Mi'nor, Inferior. 

Mis-car'riage, A bringing forth before the time. 
Mit'i-gate ; To make less severe ; to alleviate ; to assuage. 



GLOSSARY. 1001 

Mo'dus Op-e-ran'di, Mode of operating. 

Mo-ment'um, Force ; quantity of motion in a moving body. 

Mon-o-rna'ni-a, Derangement on one particular subject. 

Mor'bid, Diseased ; sickly ; not sound and healthful. 

Mor-bif'ic, Causing disease; generating a sickly state. 

Mor'phi-a, A vegetable alkaloid extracted from opium. 

Mu'ci-lage, A glutinous, slimy substance. 

Mu-ci-lag'in-ous, Slimy; ropy; moist, soft, and lubricous. 

Mu'cous Rale, The sound occasioned by mucus in the air-passages. 

Mu'cus, A sticky, tenacious fluid. 

Mu'cous, Viscid or slimy; gummy; tenacious. 

Mu'co Se'rous, Mixture of mucus and serum. 

Mu'co San-guin'e-ous, A mixture of mucus and blood. 

Mu'cal, Of the nature of mucus. 

Mus'cae Vol'i-tan-tes, Imaginary dark spots in motion. 

Mus'cles, The organs of motion, consisting of bundles of fibres. 

Mus'cu-lar, Strong; brawny; vigorous. 

My-e-li'tis, Softening of the brain or spinal marrow. 

Nar-cot'ic, Medicines producing torpor or sleep. 
Nar'co-tine, An alkaloid obtained from opium. 

Nar'co-tize, To bring under the effects of a narcotic; to make sleepy. 
Na-res, Nostrils. 
Nates, The buttocks. 

Nau'sea, Sickness of the stomach, with a propensity to vomit. 
Nau'se-ants, Substances producing nausea. 
•Nau'se-a-ting, Loathing ; making sick ; producing disgust. 
Ne-cro'sis, Dry gangrene ; an inflammation of a bone, ending in death. 
Ne-phral'gi-a, Disease or pain in the kidneys. 

Ne-phri'tic,' Pertaining to the kidneys ; relieving disorders of the kid- 
neys. 
Ne-phri'tis, Inflammation of the kidneys. 
Nerv'ous, Easily agitated ; irritable. 
Neu-ra-mil'la, Very minute nerves. 

Neu'tral-ize, To render inactive ; to destroy particular properties. 
Neu-ral'gi-a, Painful affections of the nerves. 
Ni'dus, A nest ; a repository for eggs. 
Noc-turn'al, Done or happening at night. 
Nod'ules, Small irregular lumps or knots. 
Nod'u-la-ted, Having little knots or lumps. 



1002 GLOSSARY. 

No-sol'o-gist, One who classifies diseases systematically. 

No-sol'o-gy, A systematic classification of diseases, with names and defini- 
tions. 

Nos-o-log'ic-al, Pertaining to nosology ; systematic. 

Nor'mal, Natural; healthy. 

No'lens Vo'lens, Willing or unwilling; whether he will or not. 

Nox'ious, Hurtful; unwholesome. 

Nu'cle-i, Parts about which matter is collected ; central part of a body ; 
the plural of nucleus. 

Nu'ga-to-ry, Trifling; useless; of no force. 

Nui'sance, That which annoys ; things offensive. 

Nu'tri-ent, Nourishing; promoting growth. 

Nu'tri-tive, Having the quality of nourishing. 

Nu-tri'tious, Nourishing. 

O-bes'i-ty, Excessive fatness. 

O-bese', Fat; gross. 

Ob-tend', To oppose ; to stretch against or before. 

Ob-tend'ing, Opposing. 

Ob-tuse'ness, Dulness ; want of quick sensibility. 

Oc-cip'it-al, Pertaining to the back part of the head. 

Oc'ci-put, The back part of the head. 

Oc'ci-pa-ted, Like the occiput or back of the head. 

(E-dem'a-tous, Swelled, as in a dropsical state of the skin. 

(E-de'nia, A tumor. 

(E-soph'a-gus, The gullet. 

Of-fic'i-nal, Relating to or sold in a shop, as medicine. 

O-men'tum, A membranous covering of the bowels attached to the 

bowels ; the apron. 
O'nus, The burden 

O-pac'i-ty, Darkness ; not penetrable to rays of light. 
O-pal-es'cent, Reflecting a milky or pearly light from the interior. 
O'pa-line, Milky white. 

O-paque', Not transparent; impervious to light. 
Oph'thal-mi-a, Inflammation of the eye or its appendages. 
O'pi-ate, Medicine producing sleep or inaction. 
Or-gan'ic, Possessed of organs ; produced by organs. 
Or-gan-iz'a-ble, That may be organized or constructed systematically. 
Or'gasm, Immoderate excitement or action. 
Or'i-fice, The mouth or aperture of a tube, pipe, or other cavity. 



GLOSSAEY. 1003 

Or-thop-nce'a, Disease in which the patient can breathe only in an erect 

posture j difficulty of breathing. 
Os'cil-la-to-ry, Swinging; moving backward and forward, as a pendulum. 
Os-cil-la'tion, Vibration ; moving backward and forward. 
Os'se-ous, Bony ; resembling bone. 

Os'si-fied, Changed into bone, or hard substance like bone. 
Os Coc'cy-gis, The last bone of the spinal column ; crupper-bone. 
Os Il'i-um, Haunch-bone. 
Os Is'chi-um, Hip-bone. 
Os In-no-mi-na'ti, Side of the pelvis. 
Os Pu'bis, Front of the pelvis. 
Os Sac'rum, The hinder part of the pelvis 
Os Fem'o-ris, The thigh-bone. 
Os U'te-ri, Mouth of the Womb. 
O-tal'gi-a, Earache. 
O'va-ries — O-va'ri-um — The parts in which the foetus is supposed to be 

formed. 
O'vum, An egg. 
O'va, Plural of Ovum. 
Ox'y-mel, A mixture of vinegar and honey. 
O-zae'na, Inflammation of the nostrils. 

Pal'li-ate, To reduce in violence ; to lessen ; to abate. 

Pal'lid, Pale ; wan ; deficient in color. 

Pal'lor, Paleness. 

Pal'pi-tate, To flutter ; to beat, as the heart. 

Pan'cre-as, A gland of the abdomen ; the sweet-bread. 

Pan-cre-at'ic, Pertaining to the pancreas. 

Pa-pil'lae, Little teats ; the termination of nerves. 

Pap'u-lae, Pimples; an eruption of the skin. 

Pap'u-lous, Full of pimples. 

Pap'il-la-ry, Little teats. 

Par-a-cen-te'sis, The perforation of the body for the evacuation of fluids. 

Par'a-site, Plants or animals living on the bodies of others, and deriving 

their nourishment from them. 
Par-a-lyt'ic, Affected with palsy; inclined or tending to palsy. 
Pa-ral'y-sis, Palsy. 
Par'a-lyze, To affect with palsy. 

Par'a-mount, Superior to all others ; of the highest order. 
Par-a-ple'gi-a ; A kind of palsy affecting the lower part of the body. 



1004 GLOSSARY. 

Pa-ren'chy-ma, The proper substance of an organ. 

Pa-ri'e-tal, Pertaining to a wall ; defending, like a wall. 

Pa-ri'e-tes, Parts. 

Pa-rot'id Glands, (Hands below the ear. 

Par'ox-ysm, A periodical fit or attack of a disease. 

Par-tu'ri-ent, Bringing forth; about to bring forth. 

Par-tu-ri'tion, Act of being delivered or of bringing forth 

Pa-teFla, The knee-pan, or cap of the knee. 

Path-o-log'ic-al, Relating to pathology, or doctrine of disease. 

Pa-thol'o-gist, One who treats of pathology. 

Pa-thol'o-gy, Doctrine of the cause and nature of disease. 

Pau'ci-ty, Scantiness; smallness of quantity. 

Pec'cant, Corrupt ; bad ; not healthy. 

Pec-to-ril'o-quy, When a patient's voice, distinctly articulated, seems to 

proceed from the point of the chest on which the ear or stethoscope 

is placed. 
Ped'i-lu-vi-um, A bath for the feet. 
Pel'li-cle, A thin skin or film. 
Pel-lu'cid, Perfectly clear; transparent. 

Pel'vis, Cavity of the body constituting the lower part of the abdomen. 
Pel'vic Vis'cera, The organs contained in the pelvis. 
Pem'phi-gus, An eruption of vesicles. 
Per-cus'sion, The shock produced by the collision of bodies ; the act of 

striking one body against another. 
Per'co-late, To strain through ; to filter. 

Per-co-la'tion, The act of straining, as liquor through porous stone. 
Per'fo-rate, To bore through ; to make holes. 
Per-fo-ra'tion, The act of boring or piercing through. 
Per-i-car'di-um, The membranous sack enclosing the heart. 
Per-i-car'di-al, Belonging to the pericardium. 
Per-i-car'di-tis, Inflammation of the pericardium. 
Per-i-ne'um, The part between the vagina and fundament. 
Pe-ri-od'ic-al, Happening at regular intervals. 
Pe-ri-o-dic'i-ty, The quality of being periodical. 
Per-i-os'te-um, A nervous vascular membrane investing the bones. 
Per-i-os'ti-sis, Inflammation of the periosteum. 
Pe-riph'e-ry, Circumference of a circle. 
Per-i-stal'tic, The motion by which the intestines push forward their 

contents. 
Per-i-to-ne'um, The membrane which invests the bowels. 



GLOSSARY. 1005 

Per-i-to-ne'al, Pertaining to the peritoneum. 

Per-i-ton-i'tis, Inflammation of the peritoneum. 

Per'me-ate, To pass through the pores or interstices of a 'body. 

Per'me-a-ting, Passing through the pores of a body. 

Per-ni'cious, Destructive; tending to injure or destroy. 

Per-sist'ent, Continuing ; mot falling off. 

Per-spi-ra'tion, Sweat j matter perspired. 

Per-vert'ed, Turned from right to wrong. 

Pes-ti-len'tial, Producing or tending to produce infectious diseases. 

Pes'sa-ry, An instrument for supporting the uterus. 

Phan'tasm, Something imagined ; vain airy appearance. 

Phar-ma-ceu'ti-cal, Pertaining to the art or knowledge of preparing 
medicines. 

Phar-yn'ge-al ? Belonging to or connected with the pharynx. 

Phar'ynx, The top of the gullet or oesophagus. 

Phe-nom'e-na, Appearances. 

Phle-bot'o-my, The act or practice of bleeding for the cure of diseases. 

Phlegm, The viscid matter secreted in the throat. 

Phleg'rnon, An inflammatory tumor. 

Phleg'mon-ous, Inflammatory. 

Phleg-ma'sia Do'lens, Milk-leg. 

Phre-ni'tis, Inflammation of the brain. 

Phthis'ic-al, Breathing hard ; having or belonging to the phthisic ; con- 
sumptive. 

Phos-phat'ic, Containing phosphorus. 

Phys-i-o-log'i-cal, Relating to the science of the properties and functions 
of living beings. 

Phys-i-ol'o-gy, The science of life. 

Pil'lu-lar, In the form of pills. 

Pi'a Ma'ter, A thin membrane immediately investing the brain. 

Pla-cen'ta, The afterbirth. 

Plas'tic, Yielding easily ; capable of being moulded or shaped. 

Pledg'et, A fold of lint or cotton laid over a wound to imbibe the matter 
discharged. 

Pleth'o-ra, Fulness of habit ; excess of blood. 

Pleth'o-ric, Having a full habit of body. 

Plen'i-tude, Fulness ) plethora ; complete competence. 

Pleu'ra, A thin, membrane covering the inside of the thorax, also invest- 
ing the lungs. 

Pleu'ri-tis ; Inflammation of the pleura. 



1006 GLOSSARY. 

Plex'us, A union of fibres, nerves, or vessels. 

Pneu-mo'ni-a, Inflammation of the lungs, or lung fever. 

Pol'y-pus, A tumor with a narrow base resembling a pear. 

Por'tal Veins, Veins entering the liver. 

Pos-te'ri-or, Later in time ; coming after. 

Post-Mor'tem, An examination of a body after death. 

Pos-te'ri-or Na'res, Back part of the nostrils. 

Po-ta'tion, A draught; drink. 

Po'tent, Powerful; strong; efficacious. 

Po-ten'ti-al Cau'te-ry, The destruction of vitality with other substances, 

instead of a red-hot iron. 
Pre-cor'dia, Same as Epigastrium — Pit of the stomach. 
Pre-co'cious, Premature ; rapid growth in body or mind. 
Pre-dis-posed', Previously inclined, as the body to disease 
Pre-ma-ture'ly, Too soon ; before the proper time. 
Pre-mo-ni'tion, Previous warning or notice. 
Pre-mon'i-to-ry, Giving warning or notice. 

Pre'puce, The foreskin ; a prolongation of the skin of the penis. 
Pre-ter-nat'u-ral, Beyond or different from what is natural. 
Pri-o'ri, Before. 

Pro'cre-ate, To generate ; to produce. 
Pri'ma-ry, First in time ; original. 
Pri-ma'ri-ly, Originally; first. 
Pro-lapsed', Fallen down or out. 
Pro-lap'sus, The falling down or out. 

Prog-no' sis, The art of foretelling the course and event of a disease. 
Pro-gen'i-tor, A forefather. 

Pro-phy-lac'tic, Defending from disease ; a preventive. 
Prop'a-gate, To generate ; to continue to multiply. 
Prop-a-ga'tion, The continuance or multiplication of the kind. 
Pro'te-an, Readily assuming different shapes. 
Pro-trude', To be thrust out or forward. 
Pro-tu'ber-ance, A swelling or tumor on the body. 
Pros'tate Gland, A gland situated at the neck of the bladder. 
Prox'i-mate Cause, The immediate cause preceding and producing the 

effect. 
Pseu'do-Mem'bra-nous, A membrane artificially formed. 
Pu'ber-ty, Ripe age. fc 

Pu'bes, The share-bone. 
Pu-den'da, The parts of generation. 






GLOSSARY. 1007 

Pu'er-ile Breath'ing, Breathing like a child. 

Pu-er'pe-ral, Pertaining to childbirth. 

Pul'nio-na-ry, Relating to or affecting the lungs. 

Pul'mo-na-ry (E-de'ma, Dropsy of tlie lungs. 

Pulp, A soft mass; marrow. 

Pulse, To beat, as the arteries. 

Puls'a-to-ry, Beating; throbbing; as the heart or arteries. 

Punc'tum Sa'li-ens, The point at which life begins. 

Punc'ture, To pierce with a small instrument. 

Pun'gent, Sharp ; acrid ; biting. 

Purg'a-tive, A medicine that evacuates the bowels. 

Pur-pu'ra, An eruption of small purple specks and patches. 

Pus, The yellowish-white matter secreted in ulcers and wounds. 

Pu'ru-lent, Consisting of or partaking of the nature of pus. 

Pus'tules, Small swellings on the skin, or blisters. 

Pus-tu-la'tion, Forming pustules ; covered with pustules or blisters. 

Py-lo'rus, The lower and right orifice of the stomach. 

Py-ro'sis, Water-brash, or heartburn. 

Quan'tum, The quantity ; the amount. 
Quo-tid'ian, Returning daily. 
Qui'nia, Quinine. 

Rab'id, Furious; raging; mad, as a rabid dog. 

Ra'di-ate, To emit or send out in direct lines from a point or surface, as 

heat 
Rad'i-cles, The extreme minute vessels, as the capillaries. 
Ram-i-fi-ca'tions, Branchings ; divisions and subdivisions 
Ram'i-fied, Divided into branches. 

Rale, A morbid sound attending certain diseases of the lungs. 
Ra-ti-oc-i-na'tion, Act or process of reasoning. 
Ra-ti-o-na'le, A detail with reasons. 
Re-ac'tion, Any action in resisting other action or power. 
Re-ces'sion, Withdrawing; retiring; relaxing. 
Rcc'tum, The last of the large intestines. 
Re-cum'bent, Reclining; in a lying posture. 
Re-cur'rent, Returning from time to time. 

Re-cu'per-a-tive, Tending to recovery; giving health and strength. 
Re-dun'dance, Excess; superabundance. ' 
Rcd'gum, An eruption so called. 
64 



1008 GLOSSARY. 

Re-duc'tion, A lessening. 

Re'flex, Directed back. 

Re-frig'er-ant, Cooling; allaying heat, as a medicine or drink. 

Re-gur-gi- ta'tion, The act of throwing back again ; reabsorption. 

Reg'i-men, Regulation of food, air, exercise, etc. 

Re-ject', To refuse to receive ; to cast off. 

Re-lapse', To fall back or return from recovery. 

Re-lax', To slacken or loosen ; to open ; to remit or abate. 

Re-mit'tent, Abatement; cessation. 

Re-mis'sion, Moderation ; diminution of the violence of a disease. 

Rep-a-ra'tion, The act of repairing ; restoration. 

Re-par'a-tive, Restoring; repairing. 

Re-pel'lent, Medicine having power to drive back morbid humors. 

Re-ple'tion, Fulness of blood; plethora. 

Re'nal, Relating to the kidneys. 

Re-solVents, Medicines having power to disperse inflammation and prevent 
the suppuration of tumors. 

Res-o-lu'tion, The dispersing of inflammation; the breaking up and dis- 
appearance of fever. 

Res'o-nance, A return of sound, or echoing back. 

Res-pi-ra'tion, The act of breathing. 

Res-pi'ra-to-ry, Serving for respiration ; pertaining to respiration. 

Re-su-m6', A summing up ; a condensed statement. 

Re-sus-ci-ta'tion, The act of reviving from apparent death. 

Re-sump'tion, Act of resuming; taking back. 

Re-tard'ed, Hindered in motion ; delayed. 

Re-ten' tion, Keeping back ; power of retaining, as some natural discharge. 

Retch'ing, Heaving; to vomit. 

Re-tic'u-la-ted, Netted ; resembling net-work. 

Ret'i-na, The nervous coat of the eye. 

Ret'ro-grade, Declining from a better to a worse state. 

Re-tro-ces'sion, The act of going back. 

Re-tro-ver'sion, A turning or falling backward. 

Re-vul'sion, The act of diverting a disease from one part of the body to 
another. 

Re-vul'sive, Having the power of revulsion or withdrawing. 

Rhon'chus, A rattling. 

Ri-gid'i-ty, Stiffness ; want of pliability. 

Rig'ors, A convulsive shuddering with cold. 

Ro-sa'ce ; An eruptive disease. 



GLOSSARY. 1009 

Ro-se'o-la, Scarlet-rash. 

Ru-be'o-la, The measles. 

Ru-be-fa'ci-ents, External applications producing redness of the skin. 

Ru'gose, Wrinkled ; full of wrinkles. 

Rup'ture, To break ; to burst ; protrusion of the contents of the abdomen. 

Sac'runi, Arch-bone of the pelvis. 

Sa'line, Consisting of salt ; of the nature of salt. 

Sa-li'va, The fluid secreted in the mouth. 

San'gui-fi-ea-tion, The production of blood. 

San-guin'e-ous, Abounding with blood; constituting blood. 

San-guin'o-Nerv'ous, Partaking of the sanguineous and nervous tempera- 
ments. 

Sa'ni-ous, Emitting unhealthy discharges, as from sores. 

Sa'ni-es, A thin reddish discharge from wounds or sores. 

Sa'pi-ent, Wise ; sage ; discerning. 

Sar'co-cele, A fleshy firm tumor of a testicle, not inflammatory. 

Sat'u-rate, To impregnate ; to fill up to fulness. 

Sat'urn-ine Lo'tion, Lead water. 

Sca'brous, Rough ; rugged ; having hard, short, rigid points. 

Scal'pel, A dissecting-knife ; a surgical instrument. 

Scap'u-la, The shoulder-blade. 

Scar'i-fy, To scratch or cut the skin; to make small incisions with a 
lancet. 

Scar-la-ti'na, Scarlet fever. 

Sci-at'ic — Sci-at'i-ca — A rheumatic affection of the hip-joint; pertaining 
to or affecting the hip. 

Scir'rhus — Scirrhous — Indurated ; hard ; knotty, as a gland. 

Scle-rot'ic-a, The firm white outer coat of the eye. 

Scor-bu'tus, Scurvy. 

Scro'tum, The bag containing the testicles. 

Se-ba'ceous, Suet-like ; made of tallow or fat 

Se-crete', To separate a fluid or substance from the blood, as the 
glands. 

Se-cre'tion, The act of secreting; the matter secreted. 

Se'cre-to-ry Ves'sels, Organs that separate fluids from the blood. 

Sed'a-tive, Medicine allaying irritability ; moderating ; composing. 

Sed'en-ta-ry, Accustomed to sit much ; with but little exercise. 

Sed'i-ments, Settlings; dregs. 

Sed'u-lous, Steadily industrious ; diligent; persevering. 



1010 GLOSSARY. 

Se'men, The seed. 

Sem'i-Con'flu-ent, Slightly running together. 

Sen-so'ri-uin, The seat of sense and perception. 

Sen'tient, Having sensation. 

Se-que'la, That which follows; consequence. 

Se'rous, Thin; watery. 

Se'ro-Pu'ru-lent, Mixture of serum and pus. 

Se'rous Mem'brane, A membrane which secretes serum. 

Se'rura, The thin transparent part of the blood. 

Se'ton, A twist of silk, thread, or horse-hair, drawn through the skin 
with a needle, thus producing an ulcerous opening. 

Sex'u-al, Pertaining to sex, or distinguishing the sex. 

Shain-poo'ing, Rubbing and kneading the body after a bath. 

Si-al'o-gogue, A medicine that promotes the flow of the saliva. 

Sig'moid Flex'ure, The last curve of the colon before it terminates in 
the rectum. 

Sim'u-late, To feign; to counterfeit; to assume the appearance of some- 
thing without the reality. 

Sin'a-pism, A poultice of flour, mustard, and vinegar. 

Si'nus, An elongated abscess; a cavity in a bone or other part. 

Slough, To come off; to separate from the sound flesh. 

Som' no-lent, Sleepy; drowsy. 

Sol'u-ble, That may be dissolved. 

So-lu'tion, State of being dissolved ; process of dissolving into a fluid. 

Sor'des, Foul matter; excretions; useless or rejected matter. 

Spasm, Violent contraction of the muscles or muscular fibres. 

Spas-mod'ic, Relating to or consisting in spasm. 

Spe-cif'ic, Definitely particular; an efficacious medicine. 

Spec'u-lum, An instrument for dilating and keeping open certain parts 
of the body, so as to be seen. 

Spec'tral, Like a spectre. 

Sphinc'ter, Muscles that contract the orifices they surround. 

Sphinc'ter A'ni, The sphincter muscle of the rectum. 

Spi'nal Me-nin'gi-tis, Inflammation of the membranes covering the spinal 
marrow. 

Spi'nal My-e-li'tis, A depreciation of the substance of spinal marrow. 

Spi'nal, Pertaining to the spine or back-bone. 

Spi'na Bi-fi'da, Softening of the back-bone. 

Spine, The back-bone. 

Spi'nous, Full of spines; armed with thorns; thorny. 



GLOSSARY. 1011 

Spinous Pro'cess-es, Projections on the bones of the back. 

Spleen, The milt ; a spongy viscus. 

Splen'e-tic, Peevish; fretful. 

Sple-ni'tis, Inflammation of the spleen. 

Spu'ta, Spittle; matter ejected from the lungs. 

Squa'mous, Scaly ; covered with scales. 

Ster-eo-ra'ceous, Partaking of the nature of excrements. 

Ster'num, The breast-bone. 

Stcr-nu'ta-to-ry, Having the quality of exciting sneezing. 

Stim'u-lants, Articles producing a transient increase of vital energy and 

strength of action in the heart and arteries. 
Stim'u-li, Stimulants. 

Sthen'ic, Producing a morbid increase of vital energy. 
Sto-mach'ic, Pertaining to the stomach ; strengthening the stomach. 
Sto-ma-tor-rha'gia, Hemorrhage from the stomach. 
Stra-mo'ni-um, The thorn-apple. 
Stran'gu-ry, Difficulty of voiding urine. 
Stran'gu-la-ted, Obstructed. 

Strych'nia, The active principle of the nux vomica. 
Strict'ure, A drawing or morbid contraction of any passage of the body, 
Strid'u-lous, Making a small harsh sound or creaking. 
Stro'ma, A bed ; that in which something is imbedded. 
Struc'tu-ral, Pertaining to the organization of bodies. 
Stru'mous, Scrofulous. 

Stupe, Cloth dipped in warm medicaments; sweating bath. 
Stu'por, A suspension of sensibility ; suppression of sense. 
Sub'a-eute, Acute in a moderate degree. 
Sub-cla'vi-an Vein, The great vein under the collar-bone. 
Sub-cu-ta'ne-ous, Situated under the skin. 
Sub-mu'cous, Partly mucous. 

Sub-nau'se-a-ting, Nauseating slightly ; making slightly sick. 
Sub-or'din-ate, Inferior in order ; in rank below. 
Sub-serv'i-ent, Subordinate ; acting as an assistant. 
Sub-si'dence, The act of sinking ; falling ; an abatement. 
Sub-sul'tus, Twitching, or convulsive motion. 
Sub-sul'tus Ten'di-num, Convulsive jerking of the leaders. 
Su-dor-if'ic, Medicine producing or causing sweat. 
Suf-fuse', To overspread, as with a fluid or tincture. 
Sul'phu-ret-ted, Having sulphur in combination. 
Su-per-fi'cial, Shallow ; being on the surface ; not deep or profound. 



1012 



GLOSSARY. 



Su-per-in-cum'bent, Lying or resting on something. 

Su-pine', Drowsy; indolent; careless. 

Sup-pos'i-to-ry, A kind of solid clyster. 

Sup'pu-rate, To generate or form pus or matter. 

Sup-pu-ra'tion, The process of forming pus in a wound or abscess. 

Su-prein'a-cy, Supreme ; highest in station or power. 

Sur-viv'al, An outliving ; living beyond the life of another. 

Su'i-(xen'er-is, Of a peculiar nature. 

Sut'ures, The seams uniting the bones of the skull. 

Sy-co'sis, A tubercular eruption upon the scalp or bearded part of the 

face. * 

Symp-to-mat'ic, Indicating the existence of something else pertaining to 

symptoms. 
Sym-pa-thet'ic Nerve, The great nerve in front of the spine. 
Sym'phy-sis, The union of bones by cartilage. 
Syn'co-pe, A fainting or swooning. 

Syn-o'vi-al, Secreting a lubricating fluid, as the glands in the joints. 
Syph'i-lis, An ulcerous disease on the genitals. 
Syph-i-lit'ic, Pertaining to syphilis. 
Sys-tol'ic, Pertaining to the contraction of the heart. 

Tac'tus Eu-ri-di'tus, Learned touch. 

Teg'u-ment, A cover or covering. 

Tem'per-a-ment, The peculiar habit of the body. 

Tem'per-a-ture, State ; degree of quality, as the heat of the body. 

Ten'don, A hard insensible cord or bundle of fibres which attaches 

muscles to bones. 
Te-na'cious, Adhesive; sticky; glutinous. 
Te-nes'mus, Straining of the bowels, as in flux. 
Tense, Stretched ; strained to stiffness ; drawn tight. 
Tep'id, Lukewarm ; moderately warm. 
Te-rax'i-cum, Extract of Dandelion. 
Ter'tian, Occurring every third day. 
Ter'ti-a-ry, Third; of the third formation. 
Tes'ti-cles, Male organs of generation. 
Tes'sel-a-ted, Checkered; formed in little squares. 
Tet'a-nus, Locked-jaw. 
Te-tan'ic, Pertaining to or denoting tetanus. 
Texture, The arrangement of parts forming an organ. 
Ther-a-peu'tic, Curative ; that pertains to the healing heart. 



GLOSSARY. 1013 

Ther-a-peu'ti-cal, Pertaining to the employment of remedies. 

Tho-rac'ic, Pertaining to the thorax or chest. 

Tho-rac'ic Duct, The trunk of the absorbent vessels. 

Tho'rax, The cavity of the chest. 

Tib'i-alj Pertaining to the large bone of the leg. 

Tic Dou-lou-reux', Neuralgia of the face. 

Tinc'ture, Spirit containing medicinal properties in solution. 

Tinc'ture O'pii, Laudanum. 

Tin'ni-tus Au'ri-um, Ringing in the ears. 

Tis'sues, Texture or organization of parts. 

Tit-il-la'tion, A tickling. 

Ton'ic, Medicine that increases strength ; bracing. 

To-nic'i-ty, Tone. 

Ton'sil, A glandular body in the throat or fauces. 

Ton-sil-li'tis, Inflammation of the tonsils. 

Top'ic-al, Local; external. 

Tor'pid, Dull ; stupid \ inactive. 

Tor'por, Numbness ; loss of motion or power of motion. 

Tor'mi-na, Severe pain. 

Tort'u-ous, Twisted ; wreathed ; winding. 

Tra'che-a, The wind-pipe. 

Trans-lu'cent, Semi-transparent ; admitting rays of light without permit- 
ting objects to be seen. 

Trans'verse, Lying across, or in a cross direction. 

Trau-mat'ic Tet'a-nus, Tetanus caused by wounds. 

Tre'mor, A shivering or shaking; involuntary trembling. 

Tro'car, A surgical instrument for tapping dropsical persons and the like. 

Tu'ber-cle, A pimple ; a swelling ; a tumor. 

Tu-ber'cu-lous, Affected with tubercles. 

Tu-ber-cu-lo'sis, A disease attended with tubercles; consumption; 
scrofula. 

Tu'bu-lar, Having the form of a tube or pipe. 

Tu-me-fac'tion, A tumor or swelling; process of rising or swelling. 

Tu'me-fied, Swelled; enlarged. 

Tu'mid, Enlarged ; distended ; swelled. 

Tu'mor, A morbid enlargement of a particular part. 

Tur'bid, Thick; muddy; not clear. 

Tur-ges'cence, Act of swelling; state of being swelled. 

Tur'gid, Swelled; bloated; distended. 

Tym-pa-ni'tes, A distension of the abdomen by wind. 



1014 GLOSSARY. 

Tym-pan'ic, Drum-like ; relating to tympany or tympanites. 
Tym'pan-uin, The drum of the ear. 

Ul'cer, A sore, generally ill-conditioned. 

Ul'cer-ate ; To be formed into an ulcer ; to become ulcerous. 

Ul'cer-ous, Having the nature of an ulcer ; discharging matter. 

Ul'tra, Beyond; in the extreme. 

Um-bil'i-cate, Navel-shaped ; depressed in the middle. 

Um-bil'i-cus, The navel. 

Unct'u-ous, Fat; oily; greasy. 

Un-di-lu'ted ; Not diluted; not thinned or weakened. 

Un-gu-ent'um, In the form of an ointment. 

U'ni-form, Even; regular. 

Un-phar-ma-ceu'tic-al, Not according to correct principles of mixing 

medicine. 
U'ra-tis, Combinations with uric acid. 

U're-a, A peculiar crystallized substance held in solution in the urine. 
U're-ter, A tube conveying the urine from the kidneys to the bladder. 
U-re'thra, The canal by which the urine is conducted from the bladdc? 

and discharged. 
U'rine, Fluid secreted by the kidneys. 
U'rin-a-ry, Pertaining to urine ; holding urine. 
U'ric, Of or belonging to urine. 
Ur-ti-ca'ria, Nettle-rash. 
U'te-rus, The womb. 
U'ter-ine, Pertaining to the womb. 

U'te-ro-G-es-ta'tion, Gestation in the womb from conception to birth. 
U'vu-la, A small conical body projecting from the middle of the soft 

palate. 

Yac'cine ? Belonging to or matter of the cow-pox. 

Va-cu'i-ty, Emptiness ; state of being unfilled. 

Va'ga-ries, Whims ; wild freaks ; wandering of the thoughts. 

Va-gi'na, The passage to the womb. 

Vag'in-i-tis, Inflammation of the vagina. 

Val-e-tu-di-na'ri-an, Sickly; weak; infirm. 

Valv'u-lar, Containing valves. 

Var'i-ces, Dilated veins. 

Var'i-cose, Enlarged or permanently dilated. 

Var-i-eel'la ; Chicken-pox. 



GLOSSARY. 1015 

Va-ri-o'lous ; Having pits like those of small-pox. 

Va'ri-o-loid, Modified small-pox. 

Va-ri'o-la, Small-pox. 

Va'ri-o-lus, Small-pox matter. 

Vas'cu-lar, Pertaining to vessels ; full of vessels. 

Ve'hi-cle, A substance in which medicine is taken. 

Vel'um Pen'du-lum Pa'la-ti, The soft palate or fleshy substance hanging 

over the tongue. 
Vein, A tube carrying blood to the heart. 
Ve-ne're-al, Connected with sexual intercourse. 
Ven'e-ry, Sexual intercourse. 

Ve'na Ca'va As-cend'ens, The great ascending vein. 
Ve'nous, Contained in the veins ; belonging to the veins 
Ve'nous Rad'i-cles, The extreme or capillary veins. 
Ven-e-sec'tion, Bloodletting. 
Ven'ti-late, To give circulation to pure air. 
Ven'tri-cle, A cavity either in the heart or brain. 
Ver'te-brae, Joints in the spine or back-bone. 
Ver'teXj The crown or top. 
Ver'ti-go, G-iddiness; dizziness. 
Ve-ra'trum Vi-ri'de, The white hellebore. 

Ves'i-cle ; Any small membranous cavity in animals or vegetables. 
Ves'i-ca-ting, Blistering. 

Ve-sic'u-lar, Consisting of vesicles j pertaining to vesicles. 
Vi'bra-to-ry, Quickly moving back and forth. 
Vi-ca'ri-ous-ly, In the place of another. 
Vi-cis'si-tudes, Changes; revolutions. 
Vi'ce-Ver'sa, The case being reversed. 
Vir'u-lent, Poisonous. 
Yi'rus, Contagious matter of an ulcer. 
Vi'rous, Poisonous; hurtful; baneful. 
Vis'ce-ra, The organs contained in any cavity of the body. 
Vis'ce-ral, Pertaining to the viscera ; feeling ; sensibility. 
Vis'cid, Glutinous; tenacious; sticky. 
Vis'cus, An entrail ; an internal organ of the body. 
Vis'cous, Clammy; sticky; adhesive. 
Yis Med'i-ca-trix Nat'u-ra, Vital principle. 
Vi'tal, Containing life ; essential to life. 

Vi-tal-i-za'tion, Act of infusing the vital principle ; giving life. 
Vi'ti-ate ; To injure the substance or qualities of a thing. 



1016 GLOSSARY. 

VYti-a-ted, Depraved ; rendered impure ; defective. 

Viv'i-fy-ing, Enduing with life ; communicating life. 

Vol'a-tile, Subject to evaporate; to fly off in vapor. 

Vo-li'tion, The power of willing or determining. 

Vol'vu-lus, A descent of an upper portion of the bowels through the 

rectum. 
Vo-ra'cious, G-reedy in eating ; ravenous ; very hungry. 
Vo-rac'i-ty, (greediness of appetite. 
Vul'va, The birthplace. 

Wheals, An eruption in the form of stripes 

Zest, Relish ; to give a relish. 

Zo'o-phyte, A low order of animal existence, as the coral insect. 



INDEX OF MATERIA MEDICA AND RECIPES. 



PAGE 

Anodyne Carminative 955 

Agrimony 904 

Alder, Black 904 

Aloetic Pills 958 

Alterative Syrup 954 

Alum Root 905 

Anodyne Alterant 953 

Angelica 905 

Antimonial Solution 959 

Antispasmodic Pills 959 

Antisyphilitic Syrup 956 

Apple, Peru 906 

Arbutus 906 

Arrow-Root 906 

Asarabacca Swamp 906 

Avens, Common 906 

Balm 907 

Barberry 907 

Bayberry 907 

Beech Drops 908 

Bitter-Sweet 908 

Blackberry 908 

Blazing Star 908 

Blood Root 908 

Bone-Set .,.. 909 

Broomrape, Virginia 909 

Burdock 909 

Calimus 909 

Camomile 910 

Wild 910 

Cancer Root 910 

Candleberry Myrtle 910 

Cough Mixture 959 

Caraway 910 

Carrot, Wild 910 

Castor Oil 910 

Centaury 911 

Cherry Tree, Wild 911 



PAGE 

Cinquefoil 911 

Columbo, American 911 

Compound Syrup of Valerian. 953 

Comfrey 912 

Chloroform Liniment 953 

Coriander 912 

Crane's Bill 912 

Crow Foot 913 

Dandelion 913 

Deadly Nightshade 913 

Devil's Bit 913 

Dewberry 913 

Dill 913 

Diuretic Pills 959 

Dock, Water 913 

Dogwood 914 

Elder, Common 914 

Elecampane 915 

Elm, Slippery 915 

Emulgent Pills 954 

Emetic Weed 915 

Emulgent and Tonic Pills.... 955 

Ergot 916 

Featherfew 917 

Fennel, Sweet 917 

Fern, Female 917 

Male 917 

Flag, Blue 918 

Sweet 918 

Flax-Seed 918 

Foxglove 918 

Garlic, Common 919 

Gentian 920 

Ground Holly 920 

Hemlock 921 

1017 



1018 



INDEX OF MATERIA MEDICA AND RECIPES. 



PAGE 

Henbane, Black 922 

Hops .. 922 

Horehound 923 

Hor, i e- radish 923 

Houseleek 924 

Hyssop 924 

Indian Physic 924 

Tobacco 924 

Turnip 924 

Jamestown Weed 925 

Jerusalem Oak 925 

Juniper, Common 925 

Lemon Tree 925 

Lettuce 926 

Lithontriptic 955 

Lichen — Lungwort 927 

Madder, Wild 927 

Magnolia 927 

Maiden Hair 928 

Male Fern 928 

Mallow, Common 928 

May-Apple 928 

Marsh Mallow 928 

May-Weed 929 

Mezereon 929 

Motherwort 929 

Mugwort 930 

Mulberry Tree 930 

Mullen 931 

Nightshade, American 931 

Deadly 931 

Oak 933 

Onions 933 

Orange Tree 933 

Peach Tree 934 

Pennyroyal 934 

Peppermint 934 

Pepper, Red... 934 

Pink Hoot 935 



PAGE 

Plantain 935 

Pleurisy Root 936 

Poison Oak 936 

Poke Weed 936 

Pomegranate 937 

Poplar Tree 937 

Poppy, White 938 

Potato, Sweet 938 

Wild 938 

Preparations of Slippery-Elm 956 

Prickly Ash 938 

Pride of China 939 

Puccoon 939 

Queen of the Meadows 939 

Raspberry 940 

Red Cedar 940 

Remedy for Whites 955 

Rose 940 

Rue 941 

Sarsaparilla 941 

Sage 941 

Sassafras 941 

Scurvy Grass 942 

Seneka Snake Root '942 

Senna, American 943 

Sorrel ' 943 

South Sea Tea 944 

Sumach, Common 944 

Tansy 944 

Thorn Apple 945 

Thorough wort 946 

Thyme 947 

Tonic Syrup 954 

Tobacco 947 

Valerian, Wild 947 

Virginia Snake Root 948 

Walnut, White 948 

Willow ' 949 

Yarrow 949 



INDEX. 



PAGF,. 

Abdominal Dropsy, 626 

Abortion, how prevented, 872 

Adhesion, how brought about, 242 

Ascites, or Abdominal Dropsy, ...... 626 

Acne, or Yigor of Life, 751 

Apoplexy, 756 

Amphoric Eesonance, 258 

Anodyne, Carminative, 192, 449, 553 

Anodyne, Alterant, 449 

Appetite, Morbid, 470 

Antiphlogistic Eegimen, 244 

Aphonia, Loss of Yoice, . . . 553 

Anaemia, ........... 582 

Angina Pectoris, 572 

Anasarca, General Dropsy, . . . . . .618 

Anatomy of the Pelvis, 827 

Asthma, 554 

Ascarides, . . . . . . . . . 792 

Auscultation, 157 

Bee Tea, 638 

Bladder, Debility of, 635 

Irritability of, 634 

Spasm of, 634 

Blue Powder, 193 

Black Tongue, 220 

Blood Boils, 253 

Bronchial Bespiration, 257 

1019 



1020 



INDEX. 



PAG* 



Brain, Nervous Irritation, 674 

" Congestion of, 579 

Buboes, . . . . ,' . . . . 401 

Bougies, 409 

Butternut, Compound Syrup of, 449 

Bright's Disease, . . . 783 

Burns and Scalds, 814 

Cancer, Carcinoma, 386 

Capillaries, Office of, 135 

Cause of- Fever, etc., . . , . . 78 

Cases of Typhoid Fever, 118 

Calculous Nephralgia, . 632 

Catarrh, . . . . . 535 

Calculous, Stone in the Bladder, 649 

Catalepsy, 694 

Colic, 478 

Cholera Morbus, . . 449 

Cholera, Asiatic, . 503 

Cholerine, .......... 504 

Chronic Inflammation of the Nostrils, . . . . . 555 

Chorea, St. Yitus's Dance, ....... 714 

Chilblains, 819 

Cynanchie Trachealis, Croup, 562 

Chicken-Pox, 202 

Cholera Infantum, 191 

Chancroid, 402 

Chronic Rheumatism, . 423 

Clap, Gonorrhea, 404 

Chloroform Liniment, ....... 53 

Contagious Diseases, Why only once Taken, ... 99 

Compound Syrup of Yalerian, 53 

Congestive Chills, 148 

Consumption, 372 

Constipation, 483 

Coryza, 555 

Concussion of the Brain, 760 

Crowing Disease, . . 550 



INDEX. 1021 



PAGIC. 



Croup, 897 

Critical Days, 94 

Cystitis, Inflammation of the Bladder, 817 

Depraved Appetite, 472 

Delirium in Fever, 92 

Dementia, .......... 698 

Dandruff, 753 

Diabetes, An Abundant Flow of Sweet Urine, . . . 642 

Diuresis, 640 

Diseases of Pregnancy, 868 

Diseases Peculiar to Infants, 890 

Diphtheria, 230 

Diarrhea, 473 

Dropsy of the Brain, 620 

" " Chest, 622 

" " Lungs, 625 

" " Abdomen, 626 

" " Ovaries, 630 

Dry Tetter, 752 

Dysentery, 169 

Ecthyma, 749 

Eczema, 745 

Encysted Dropsy, . . . . . . . . 630 

Epilepsy, 709 

Erysipelas, 216 

Enteritis, 302 

Endo Carditis, 267 

Ecstasy, 686 

Effects of Cold, . 818 

Erythema, 741 

Falling of the Womb, ........ 855 

Fainting, Syncope, \. 569 

Falling of the Teeth, 768 

Females, Diseases of, 836 

Fever, Its Mature and Phenomena, 25 



1022 INDEX. 






PAGE. 



Fever, Causes of, 45 

" Treatment of, . . . . . . 49 

" Syrup, . .52 

" Theories of, 58 

" Modes of Cure, 72 

" Mysteries Connected with, 77 

" How Local Eemedies Act in, 109 

" How it cures Other Diseases, .... 88 

" How Quinine Acts, 106 

" Particular, 118 

Fractures, . . . . ... . . .803 

" Simple, 804 

" Compound, 807 

Frozen Limbs, 818 

Gangrene, 242 

Gastritis, Inflammation of the Stomach, .... 280 

" Acute, 280 

" Chronic, 287 

Gastrorrhea, 292 

Gastralgia, 455 

Gonorrhea, Clap, 404 

Gleet, Eunning at the Eeins, ...... 409 

Gastrodynia, 455 

Hard Cancer, 387 

Hypotitis, Inflammation of the Liver, 270 

Hydropericardium, 264 

Hernia Humoralis, 408 

Heartburn, Cardialgia, 455 

Iodine, Iron, . . , . . . . . . 376 

Insanity, General, 695 

Intussuptia, .......... 493 

Inversion of the "Womb, . . . ., . . . 857 

Inflammation, 237 

" How Cures Fever, 97 

" Phenomena of 238 



l ? 



', 



INDEX. 1023 



PAGE. 



Inflammation, Phlegmonous, 241 

" of the Heart, . . . . . . 268 

" " Liver, 270 

" " Stomach, ^280 

" " Duodenum, . . . . . .299 

" " Small Intestines, .... 302 

Irritation of the Stomach, 450 

Influenza, .......... 536 

Incontinence of Urine, . . . . . • • . 670 

Insanity, .......... 695 



King's Evil, 359 

Laryngitis, Inflammation of the Larynx, . . . 559 

Liniment, Chloroform, . . 53 

Lues Yenerea, Pox, 341 

Lymph, Plastic, ......... 361 

Lumbago, . . 420 

Lithiasis, Gravel, 649 

Lunacy, 695 

Lichen, 743 

Malaria, 134 

Madness, 695 

Mania a Potu, 700 

Management after Delivery, ....... 885 

Management of the Child, 887 

Materia Medica, 904 

Measles, Kubeola, 213 

" Prevention of, 215 

Medullary Cancer, . 389 

Menorrhagia, 598 

Menses, 836 

" Eetention of, * * 841 

" Suppression of, 842 

" Profuse, . 843 

" Painful, . . 844 

Miasmatic Fever, 134 

65 



1024 



INDEX. 



Mercurials, How Injurious in Typhoid Fever 
Milk Leg, Phlegmasia Dolens, 
Miliary Eruption, 
Midwifery, Practical, 
Monomania, .... 

Motor Disorder, .... 

Moral Insanity, . . 
Mortification, . . . • . • . 
Mumps, Parotitis, . . . 

Mysteries Connected with Fever, . 

Natural Defects, . . . 

Nephritic Colic, .... 

Neuralgia, ...... 

Nettle-Kash, ... 
Nervous Eheumatism, 



Oil, Cod Liver, . ... 

Ovarian Dropsy, .... 
Obstructions of the Bowels, 
Odontalgia, Toothache, 

Palpitation, . .... 
Palsy, Paralysis, 

" General, Partial, . 

" Local, Mercurial, Lead, . 

" Shaking, Agitans, 
Parotitis, Mumps, 
Paralysis of the Bladder, 
Particular Fevers, 
Peach Leaf, Compound Syrup of, . 
Pemphigus, ..... 
Pericardium — Hydroj^s Pericardium, 
Phosphatic Gravel, 
Phlegmasia Dolens, Milk Leg, 
Phlegmonous Inflammation, 
Piles, Bleeding, .... 

Pleurodynia, .... 



PAGE. 

114 

. 779 

748 
. 879 

699 
. 688 

698 
. 242 

768 
. 77 

901 
. 632 

729 
. 742 

425 



597, 



376 
630 
491 
761 

567 
703 
704 
706 
707 
768 
635 
118 
185 
748 
624 
652 
779 
241 
771 
419 



INDEX. 1025 



PAGE. 



Pleurisy, Pleuritis, 256 

Plethora, 578 

Plastic Lymph, . . . 242 

Pleural Dropsy, . . . ... . . .622 

Pleuro-Pneumonia, . . . . . . . 156 

Poultice, Lye, 359 

Pulmonary Fever, Pneumonia, 154 

Puerile Eespiration, 157 

Percussion, 156 

Purpura, * . 587 

Pulmonary (Edema, . . . . . . . 625 

Prurigo, 744 

Porrigo, Scald-Head, . 750 

Psoriasis, . . . . . 752 

Pox, Syphilis, . .......... . . 397 

Pyrosis, "Water-Brash, .... . . . . . 458 

Pica, Morbid Appetite, ..... ... . . 472 

Quinine, How it cures Intermittents, 106 

Eeptiles, Bite of, 811 

Eespiratory Sounds, . . . . . . 157, 162 

Retention of Urine, Eenal, . . . ... . 665 

" " Yesical, . . .... . . 6Q6 

Eoseola, 741 

Eupia, 749 

Eosacea, '. . . ... • • . . . . . 751 

Eingworm, . . . . . . . . . 752 

Eunning at the Loins, Gleet, 409 

Eheumatism, Acute, . .... ... . .410 

" Bilious, • . . 414 

" Sub-Acute, 416 

" Chronic, 423 

" Nervous, 425 

Eubeola, Measles, 213 

" Prevention of, 215 

Scalds and Burns, 814 



1026 



INDEX. 



Scarlet Kash, . 

Scabies, .... 

Scorbutus, Scurvy, . 

Scirrhus, Cancer, 

Scrofula, .... 

Scarlatina, Scarlet Fever, . 

Symptoms of Typhoid Fever, 

Secreting Point, . 

Sick Headache, . . . 

Suppression of Urine, 

Stupor, .... 

Somnambulism, Sleep -Walking 

Subsultus Tendinum, 

St. Titus's Dance, Chorea, . 

Spinal Irritation, 

Sudamina, Sweat Eruption, 

Sting of Insects, 

Sore Eyes, .... 

Strophulus, Red G-um, 

Strangury, .... 

Spasm of the Ureters, 

Stomatorrhea, .... 

Spasm of the Glottis, 

" " (Esophagus, . 

Stricture of the Bowels, . 
Stomach, Irritation of, 

" Spasm of, ., . 

Sciatica, ..... 

Soft Chancre, Chancroid, 
Syphilis, Pox, ..... 
Suppuration, . . 
Scarlet Fever — Simple, Malignant, 
Small-Pox, Tariola, 
Softening, ..... 



331, 



PAGE. 

741 

747 
587 
387 
272 
204 
119 
159 
682 
646 
684 
687 
688 
714 
716 
748 
811 
898 
890 
637 
632 
595 
553 
497 
493 
450 
460 
420 
402 
397 
242 
204 
194 
159 



Tartar Emetic, How it produces a Crisis, 

Tetanus, Locked Jaw, 

Tetter — Itching, Dry, .... 



. 91 

718 
743, 747, 752 



INDEX. 1027 



PAGE. 



Tinea Capitis, Scald-Head, 750 

Tertiary Syphilis, . 398 

Topical Pemedies, . . . . . ... . . 109 

Theories of Fever, Humoral, 58 

" " Sympathetic, 61 

" " Phlegmasian, 62 

". " Cooke's, 64 

" " Present, ..... 68 

Treatment of Fever, 72 

Turpentine, How Beneficial in Typhoid Fever, . . Ill 

Typhoid Fever, . . . 118 

Tuberculosis, 372 

Toothache, Nervous, 761 

" Inflammatory, 763 

" Pneumatic, 767 



Urticaria, E"ettle-Pash, 742 

Valvular Diseases of the Heart, 268 

Varicella, Chicken -Pox, 202 

Vaccine Disease, 198 

Variola, Small-Pox, . . 194 

Vena Portarum, 276 

Venereal Disease, ........ 397 

Vomiting, .......... 463 

Volvulus, Intussusceptio, ........ 797 

Wakefulness, 684 

Warts, 755 

Water-Brash, Pyrosis, ' . . . 458 

Wet Sheet, 207 

White Swelling, 364 

Case of, . 366 

Whooping-Cough, Pertusses, 539 

Wry Neck, 367 

Worms, 785 

" Pound, 789 

" Thread, 792 



1028 INDEX. 

PAGE. 

Worms, Long Thread, .... . . . 793 

" Tape, ....... . . .794 

Wounds, ....... i . . 800 

" Poisoned, . . . . .■•■'• . . 810 

Womb, .......... 832 

" Antoeversion, ;' . . 858 

" Inversion, ... . * ... 857 

" Irritation, .... . . . . .860 

Yellow Fever, ......... 164 



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